BACKGROUND

Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due not only to its significant economic impact but also to the increasing age of our population. Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures.

Objective: Effectiveness and safety of Balloon Kyphoplasty as a method of treatment for osteoporotic vertebral fractures of the thoracolumbar spine.

Materials and Methods: From January 2003 to December 2008, 102 patients (27 males and 75 females), from 56 to 82 years old (mean age 72) were treated with balloon kyphoplasty procedures for 156 osteoporotic vertebral fractures of the thoracic or lumbar spine, in a mean follow up of 24 months (6 to 45 months). The patients had progressive and painful compression fractures more than 2 months. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height). The patients were evaluated using the visual analog scale (VAS) and the Oswestry Disability Score. Radiographs were performed postoperatively, and at 1, 3, 6, and 12 months.

Results: The score according to pain, the patient’s ability to ambulate independently and without difficulty, and the need for medications improved significantly (P < 0.001) after kyphoplasty. Vertebral height significantly increased at all postoperative intervals, with ≥10% height increases in 88% of fractures. Morphometric height ratios for treated fractures also significantly increased. There were no severe kyphoplasty-related complications, such as neurological defects, cement leakage or narrowing of the spinal canal whereas additional fractures occurred at the adjacent vertebrae at a rate of 10%.

Conclusions: Kyphoplasty provided a safe and effective treatment for pain and disability in patients with vertebral compression fractures due to osteoporosis.

Purpose: To present our experience in the treatment of sub-acromial impingement by the method of arthroscopic acromioplasty.

Material – Method: This study includes 41 patients (17 males and 24 females) with average age 53.07 years (range 22 – 69). All patients were suffering from intense pain in the shoulder joint and presented movement limitation. The patients were evaluated clinically and with plain Xrays and MRI of the region. Prior to the intervention all the patients had followed a variety of adequate conservative treatment including immobilization, anti-inflammatory therapy, physical therapy, local infiltration with corticoids and xylocain. The results proved unsatisfactory.

The surgical technique consisted of triple portal arthhroscopic intervention (anterior, posterior, lateral) and the use of a shaver for the completion of the acromio – plasty. The surgical time was 40 minutes (30 – 55)

The post – operative protocol, which included passive and active physiotherapy, was identical for all patients.

Results: The required average hospitalization was 36 hours (14 – 48). The average time needed for satisfactory rehabilitation amounted to 27 days (20 – 45). We followed closely our patients for an average of 11 months. (4 – 16). The painful symptoms disappeared thoroughly in 92.7% of our cases (38). Moderate pain persisted in 7.3% (3). Shoulder movements were fully restored in 95.1% (39). We observed no peri-operative or post – operative complications.

Conclusions: The arthroscopic airomioplasty is the surgical treatment of choice in the cases of sub-aromial impingement. The method presents no great technical difficulties. The operative time is considered short, and the results in their great majority are excellent. The hospitalization needed is minimal, the rehabilitation is rapid, and the economic cost is not significant.

We firmly believe that the arthroscopic acromio – plasty is the treatment of choice in the case of failed conservative treatment.