Study Design: Comparative, prospective follow-up study.

Objective: Comparison of outcome between patients treated with Percutaneous VertebroPlasty (PVP) using low viscosity PolyMethylMetAcrylate (PMMA) bone cement and patients treated with PVP using medium viscosity PMMA bone cement. Summary of background data. Viscosity is the characterizing parameter of PMMA bone cement, currently the standard augmentation material in PVP, and influences interdigitation and cement distribution inside the vertebral body, injected volume and extravasation, thereby affecting the clinical outcome of PVP. In PVP, low, medium and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity of cement on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation.

Methods: Follow-up was conducted using a 0–10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) Quality of Life (QoL) questionnaire before PVP and at 7 days (PI-NRS only), 1 month, 3 months and 12 months after PVP. Cement leakage was analyzed on direct post-operative CT-scanning. Injected cement volume was measured using a calibrated DICOM-viewer and the degree of interdigitation was assessed. At six and 52 weeks and at suspicion, patients were analyzed for the incidence of new fractures.

Results: Thirty consecutive patients received PVP using low viscosity PMMA bone cement (OsteoPal-V^®) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-Tech^®) for 67 OVCFs. Baseline characteristics were comparable between groups. Viscosity qualification was stated by the manufacturer. results regarding PI-NRS and SF-36 were comparable between both groups. Postoperative comparison of injected cement volume, degree of interdigitation, proportion of bipedicular procedures, incidence of new vertebral fractures and complications revealed no substantial differences between both groups. In the low viscosity group a significantly greater proportion of vertebrae showed cement extravastion (81,0% versus 71,6%, p = 0,029).

Multiple logistic analysis revealed no definitive predictive factors for the occurrence of cement leakage (yes/ no) (Odds Ratio [95% CI], P):

Severity (acc to Genant et al): 1.82 [0,69 – 4.89], 0.229

Conclusion: No major differences in clinical outcome after PVP in OVCFs using low and medium viscosity PMMA bone cement were found. Viscosity of PMMA bone cement is likely to influence cement extravastion, although this could not be confirmed.

Background and Purpose: Retrospective evaluation of short-term (8 weeks) and long-term (54 weeks) radiologic follow-up of vertebral wedge angle and anterior, center and posterior vertebral heights after Percutaneous VertebroPlasty (PVP) in type II Osteoporotic Vertebral Compression Fractures (OVCF).

Methods: Between September 2002 and August 2007 47 PVP’s were performed in 25 consecutive patients (5 male, 20 female (age 70 ± 9,5 yrs) with OVCF’s type II (mean fracture age: 35.0 weeks (range: 10.0 – 136.7)). With pre-vertebroplasty conventional radiographs and MRI’s, post-vertebroplasty CT’s and conventional radiographs follow-up of the vertebral compression fractures were analyzed.

Analysis of vertebral morphometrics with emphasis of the vertebral wedge angle and height of the vertebral body at the anterior, center and posterior border. Determining the loss and gain of height of the vertebra with OVCF pre- and post-PVP up to one year, using pre-PVP estimated heights.

Results: A mean wedge angle reduction of 2.9° and anterior- and center heigth gain of 4.4% and 5.6% directly post-PVP, posterior height remained stable. The parameters at short- and long-term follow-up compared to the pre-PVP parameters showed no significant differences accept for anterior height.

Conclusion: Besides alleviating the refractory back pain in patients a limited decrease in wedge angle and increase of anterior and center height is possible in type II OVCF. Although the long-term follow-up depicts a slight anterior height loss, the wedge angle and restored center height were stable.

Introduction: Most Vertebral Compression Fractures (VCFs) are caused by osteoporosis. This diagnosis is based on clinical and radiological findings. Even in patients with proven osteoporosis it is not always the true cause of the fractures. In literature, outcomes of bone-biopsies obtained during vertebroplasty have been described with inconsistent outcome in percentages of unexpected malignancy.

Methods: In order to determine the rate of unsuspected malignancy, ninety-eight biopsies were obtained from 81 patients (20 male, 61 female, mean age 69 years). The histological diagnosis of vertebral body biopsy specimens were analyzed in a retrospective study.

Results: Eighty-one biopsies, (82,7%) obtained from 70 patients, were suitable for histological evaluation. In a total of eleven patients (15,7%) there was a malignancy histological diagnosed, including eight patients with metastasis from a known primary tumor. Three patients (4,3%) were diagnosed with a previously undiagnosed malignancy, in two patients (2,9%) multiple myeloma and one patient (1,4%) chondrosarcoma was diagnosed. In the multiple myeloma patients the disease was in stage 1 and 2 at the time of histological diagnosis. In the remaining 70 biopsies no evidence of malignancy was found. This group contained 13 patients having a known primary malignancy, two patients with chronic corticosteroid use and four patients with a history of radiation therapy. In 10 biopsies there were no signs of osteoporosis or any other cause for the compression fracture.

Conclusion: A bone biopsy during a vertebroplasty procedure is a necessity and should routinely be performed in patients undergoing vertebroplasty procedures to rule out an unsuspected malignancy. In this study a relatively high rate of newly diagnosed malignancies as cause of VCFs was found.

In the Leiden University Medical Center (LUMC), the non-augmented direct repair method as described by Duquennoy for treatment of chronic lateral ankle instability, is used since the early eighties. To our knowledge, this procedure has not been described in English literature before. We performed a retrospective study, to assess the long-term outcome of non-augmented anatomical direct repair procedures, as originally described by Duquennoy. The procedure reassures ankle stability by retightening and reinsertion of the original talofibular and calcaneofibular ligament, without dissecting the ligamental tissue. The purpose of this study is to determine the long-term effects of the procedure in terms of postoperative quality of life, joint function and development of osteoarthritis.

Twenty-three patients who were treated in our institution between 1985 and 2002 completed the Short Form-36 Health Survey (SF-36) for assessment of postoperative quality of life and the Olerud Molander Ankle Score (OMAS) for subjective symptom evaluation. Clinical reevaluation, including physical examination of the ankle and the completion of the Ankle Society ankle-hindfoot scale (AOFAS) questionnaire, was conducted for twenty-one patients after a mean follow-up of 13±7 (range 3–22.2 years) years. At final follow-up radiographs were taken to assess the development of osteoarthritis. The mean total postoperative SF-36 and OMAS scores were 79.6 (SD ±14.6) points and 81.7 points (N= 23 patients) respectively. The mean total postoperative AOFAS score was 89.7 points (N= 21 patients). We found a significant postoperative reduction in talar tilt and anterior drawer sign. According to the AOFAS, the long-term functional outcome of the procedure was excellent in 10 patients (48%), good in 7 patients (33%), fair in 4 patients (19%) and poor in none of the treated patients. The results in terms of ankle function and stability do not seem to deteriorate in time. The procedure is seldom causing restriction in range of motion, neither a higher chance of degenerative changes in the ankle joint on the long term. We conclude that the procedure as originally described by Duquennoy is simple and effective, with a very low complication rate and does not provoke restriction in range of motion of the ankle joint.