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Vertébro et Kypho en Trauma H.Huet

02a9977d1d0662421ee64fc05f765281?s=47 journeevertebro
June 17, 2013
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Vertébro et Kypho en Trauma H.Huet

14H00 14H15 Vertébro et Kypho en Trauma H.Huet

02a9977d1d0662421ee64fc05f765281?s=128

journeevertebro

June 17, 2013
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  1. Meeting Vertébroplastie COOK Dr Hervé Huet Chu CAEN Strasbourg .

    8 Décembre 2009
  2. Plan Anatomie vertébrale et rachidienne Vertébroplastie: Rationnel/Indications/ C- Ind./Techniques .Complications

    Les Kyphoplasties ..alternatives ? Matériels Cook . Overview .Avantages .Critiques Finances : Cotations et Ghm (remboursement) Les Etudes Récentes (Invest , Vertos) Concurrence Questions diverses
  3. RACHIS OSSEUX 7 vertèbres cervicales 12 vertèbres thoraciques 5 vertèbres

    lombaires Lordose cervicale Cyphose thoracique Lordose lombaire
  4. TECHNIQUE / ANATOMIE PLAN AXIAL PLAN SAGITTAL

  5. Exemple d’architecture osseuse: Osteoporose Osteoporosis is defined as a skeletal

    disorder characterized by compromised bone strength predisposing to an increased risk of fracture. NIH Consensus Development Conference, March 27-29, 2000 Normal Bone Osteoporotic Bone
  6. RACHIS CERVICAL Vertèbres cervicales inférieures de C3 à C6 relativement

    semblables Corps vertébral parallélépipède rectangle Uncus = saillies prismatiques à la partie supérieure du plateau supérieur
  7. RACHIS CERVICAL : RX face 1 - Corps vertébral 2

    - Uncus 3 - Disque intervertébral 4 - Massif articulaire 5 - Processus épineux
  8. RACHIS CERVICAL Coupes anatomique et IRM sagittales médianes T1du rachis

    cervical et T2
  9. RACHIS THORACIQUE

  10. RACHIS THORACIQUE Fonction essentielle: protection de l’axe médullaire La participation

    du rachis thoracique au maintien de la statique et à la mobilité de l’axe rachidien est secondaire
  11. RACHIS Vertèbre thoracique type: caractères communs de T2à T9 Corps

    vertébral (1) cylindrique: – arrondi en AV et latéralement – face postérieure concave – faces supérieure et inférieure excavées – facettes costales postéro-latérales
  12. RACHIS 1 - corps vertébral T6 3 - clavicule 4

    - première côte 5 - première vertèbre thoracique T1 7 - processus articulaire inférieur 11 - pédicule 12 - pédicule gauche de T6 13 - côtes 15 - disque intervertébral 16 - processus épineux 17 - processus épineux de T6 19 - processus articulaire supérieur 21 - processus transverse 22 - processus transverse de T6
  13. RACHIS Canal vertébral thoracique (7) : – diamètre constant (+

    petit T9) – contours réguliers – globalement circulaire – contenu: moelle thoracique espace épidural : – espace épidural antérieur quasi inexistant, postérieur variable – éléments vasculaires – graisse épidurale faible (contraste naturel faible en TDM) – les racines
  14. LIGAMENTS VERTEBRAUX

  15. LIGAMENTS VERTEBRAUX

  16. RACHIS THORACIQUE 1 - corps vertébral ; 2 - disque

    ; 3 - moelle ; 4 - LCS ; 5 - graisse épidurale postérieure ; 6 - ligament jaune ; 7 - processus épineux ; 8 - ligament vertébral commun antérieur ; 9 - graisse sous-cutanée Coupes anatomique et IRM sagittales T1 et T2 1 - moelle 2 - cône médullaire 3 - LCS 4 - disque intervertébral 5 - corps vertébral
  17. RACHIS THORACIQUE Coupes axiales pédiculo- laminaires

  18. REGION THORACO- LOMBAIRE

  19. REGION THORACO-LOMBAIRE Coupes axiales anatomique et IRM T2 de la

    région thoraco-lombaire Remarque : diamètre du canal vertébral maximal au niveau de la charnière thoraco- lombaire
  20. RACHIS LOMBAIRE • Rachis lombaire pièce maîtresse du squelette axial

    du fait de la station debout • Double fonction : - rôle de stabilité et de soutien, tout en assurant une certaine mobilité = trépied (colonne antérieure et deux colonnes postérieures) - fonction de protection des structures nerveuses (cône médullaire et les racines) • Contraintes répétées quotidiennes +++ • extrême fréquence des lombalgies et des sciatiques  segment osseux le plus radiographié
  21. RACHIS LOMBAIRE Vertèbre lombaire type: – corps vertébral (1) volumineux,

    grand axe transversal, concavité postérieure, orifices vasculaires – rapport moelle rouge/moelle jaune f° âge ( conversion graisseuse progressive) – pédicules (2) épais, direction antéro-postérieure
  22. RACHIS LOMBAIRE 1 - corps vertébral L1 2 - corps

    vertébral L2 3 - corps vertébral T12 4 - corps vertébral L5 5 - processus articulaire inférieur de L2 6 - incisure vertébrale inférieure de L2 9 - pédicule droit de L2 10 - 12 ième côte droite 11 - promontoire 12 - processus épineux de L2 13 - processus articulaire supérieur de L2 14 - processus transverse G de L2
  23. RACHIS LOMBAIRE 3 - corps vertébral T12 5 - processus

    articulaire inférieur de L2 8 - interligne articulaire 9 - pédicule droit de L2 13 - processus articulaire supérieur de L2 14 - processus transverse G de L2
  24. RACHIS LOMBAIRE Coupes sagittales du rachis lombaire et de la

    charnière lombo-sacrée
  25. Vertebroplasty Technology Clinical application and new trends HUET Hervé MD.

    Interventional Neuroradiology University Hospital Intervene 1 Cairo 20 – 22 February 2008
  26. Points forts Geste à visée antalgique par consolidation du CV

    5 grandes ind. : Métas vert.,Myelome, Fr. Vert. Ostéoporotique , angiome vert. Symptomatique, fr. Vert. Traumatique Ds les fractures sur métas rachidienne l’effet antalgique est immédiat et sera complété par la radiothérapie la rupture du mur post. N’est pas une CI La présence de signe méd ou radiculaire sont le + svt une CI
  27. Points forts (suite) Ds les fract. Vert. Ostéoporotiques , la

    vertébro permet de remobiliser les patients rapidement et évite les complications en rapport avec le décubitus Les indications de la Vertébro en pathologie tumorale , seront posées après avis multidisciplinaire
  28. The Rationale

  29. The Rationale The good indication

  30. The Rationale The good indication The right approach

  31. The Rationale The good indication The right approach The safe

    filling
  32. The Rationale The good indication The right approach The safe

    filling
  33. The Rationale The good indication The right approach The safe

    filling
  34. The Rationale The good indication The right approach The safe

    filling = succes rate about 90 to 98 %
  35. Vertebroplasty : the concept Galibert and Deramond 1985 Bascoulergue 1987

    Percutaneous injection of acrylic cement into a fractured vertebra Cement already used in orthopedic surgery
  36. Indications Compression fracture osteoporosis Tumors Trauma (new) Vertebral Hemangiomas

  37. Vertebroplasty : the concept Main goal : pain release Standard

    treatment ( Lombar osteoporotic fracture): Orthopedic fixation 15 to 30 days in bed Analgesics Results : Mild or bad results on pain release Complications due to immobility Deep venous thrombosis ,Pulm. Emboli… Consolidation et effet antalgique +++ Effet anti tumoral ?
  38. Vertebroplasty : the concept 8 Months 10 days after trauma

    Orthopedic treatment: Delayed pain release Incomplete pain release Poor Vertebral consolidation 26°
  39. Vertebroplasty : the concept Vertebral body consolidation : Increased strength

    and stiffness ( reduction of pain level) (Belkof in Bone 1999 S23-S26- Harper J in Biomed Mater Res 2000 605-616) Osseous anaesthesia by chemical/thermical effect Supposed but not demonstrated…. Prevention of delayed kyphosis by anchoring fragments of vertebral body Kallmes in Radiology 2003 (27-36) Cement injection between fragments
  40. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA UNFRACTURED

    VERTEBRA Osteoporosis Primary tumor ou metastasis Hyperalgic tumor Prefractured : inflammatory osteoporotic Aggressive Hemangioma
  41. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA /

    osteoporosis Best and most popular indication in France for vertebroplasty 800 000 Vertebral compression fracture every year in the world Almost all patient can be treated because contra-indications are very rare. Local anesthesia No neurological deficit
  42. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA/ osteoporosis

    Typical compression fracture No neurological deficit High T2 signal on vertebral body Low T1
  43. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA/ osteoporosis

    Always look at adjacent vertebrae HOT SPOTS !!! Osteoporosis is a diffuse disease All vertebrae may involved High T2 is believed (our experience) to be a pre –fractured state 22% / year risk of new fracture (Lindsay JAMA 2001 320-323) Vertebroplasty on High T2 levels may be a preventive treatment
  44. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA/ osteoporosis

    Multiple injections During the same procedure
  45. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA/ osteoporosis

    High T2 signal located under the upper plate : osteonecrosis
  46. Vertebral motion (cleft) Procubitus or Hyperextension Vertical position

  47. Decrease of Régional Traumatic Angle ( RTA) 48° 30°

  48. Osteoporosis , 70 Y.O, Female

  49. None
  50. Before tt

  51. Vertebroplasty : indications and selection of patients FRACTURED VERTEBRA/ osteoporosis

    Try to obtain a massive filling of the cavity
  52. Vertebroplasty : Clinical results on osteoporotic fracture May depend on

    patient positionning !!! Standard positionning
  53. Vertebroplasty : Clinical results on osteoporotic fracture May depend on

    patient positionning !!! Orthopedic positionning Standard positionning
  54. Vertebroplasty : Clinical results on osteoporotic fracture May depend on

    patient positionning !!! Orthopedic positionning Standard positionning
  55. 13° For high grade kyphosis or delayed vertebroplasty (vertebra consolidated

    on kyphosis) Orthopedic positionning Vertebroplasty : Clinical results on osteoporotic fracture
  56. Vertebroplasty : Clinical results on osteoporotic fracture Results with orthopedic

    positionning Reduction by 10°
  57. OSTEOPLASTIE .

  58. Vertebroplasty : technical aspects Local anesthesia Rapifene 30 minutes before

    procedure Auto injection by patient if pain Proceed vertebroplasty with high quality X ray fluoroscopy Use Biplane imaging if available . Procedure time : 20 to 45 min
  59. Technic . Approach

  60. Mono or bipedicular : Monopedicular allows central and bilateral injection

    if properly placed. Vertebroplasty : technical aspects
  61. Approach technics in percutaneous vertebroplasty Dr Julien BAUD / H

    .HUET CHU Caen
  62. CHOOSING THE TARGET Two types of targets: - non-specific: for

    global vertebral body pathology (i.e. traumatic or osteoporotic fracture, or large invasive lesion). « Standard » needle positioning allows full vertebral body filling using classical and safer approach. - specific: in case of focal vertebral lesion. The route of the needle will be planned to reach (tumoral lesion) or to avoid (intraspongious discal herniation) a specific area of the vertebra.
  63. NON-SPECIFIC TARGET Standard positioning: – Axial plan: midline – Sagittal

    plan: - between the anterior and middle thirds of the body - avoiding the mid axial plan (venous cleft)
  64. NON-SPECIFIC TARGET Target is located in the inferior half of

    the vertebral body.
  65. SPECIAL CASE For minimal superior endplate fracture or contained subchondral

    superior endplate lesion (i.e. osteonecrosis), the target should be chosen into the superior half of the body.
  66. SPECIFIC TARGET Particular route will be proposed for specific cases.

    - Undetermined lesions may require biopsy for histological diagnosis and therapeutic vertebroplasty in the same time. - Some non-tumoral processes should not be touched by the needle, or filled with cement.
  67. SPECIFIC TARGET Variable parameters: – One / two needles. –

    Pedicular / extra-pedicular approach. – Right / left pedicle. – Upper / lower half of the vertebral body Constant constraints: – Spinal canal preservation. – Venous cleft plan avoiding. – Cautiousness cement filling. Don’t forget anticipating biopsy device extending approximately 2 cm forward the bevel. ! !
  68. PLANNING THE OPERATION Minimum required: - CT scan of the

    spine, including the two adjacent vertebraes (superior and inferior). - Performed the day before the operation. - Allows: - estimation of kyphosis deformation. - complex fracture visualisation. - distances measurement for percutaneous approach.
  69. PLANNING THE OPERATION Optimal radiologic checkup: - MRI of the

    spine. Protocol: sagittal T1, T2, T2 with fat suppression and T1 after IV gadolinium. axial T2 and T1 after IV gadolinium. - Performed during the two weeks before the operation. - Allows: - expecting spine bone marrow oedema. - tumoral extension, possible epiduritis. - spinal cord integrity.
  70. PLANNING THE OPERATION Sagittal T2 Sagittal T1 Sagittal STIR Vertebral

    collapse. Medullar edema. « Progressive fracture ».
  71. PLANNING THE OPERATION Sagittal STIR Before After

  72. PLANNING THE OPERATION Sagittal T2 Sagittal T1 Sagittal STIR Vertebral

    collapse. Lack of medullar edema. « Stable fracture ».
  73. PLANNING THE OPERATION 1 2 1: distance from spinous processes

    line to skin puncture. 2: needle lenght.
  74. PLANNING THE OPERATION Pedicle integrity, orientation and diameter are crucial

    factors to determine the type of access.
  75. PEDICLE PUNCTURE 1: Where to touch the pedicle with the

    needle.
  76. PEDICLE PUNCTURE 1: Where to touch the pedicle with the

    needle.
  77. PEDICLE PUNCTURE 1: Where to touch the pedicle with the

    needle.
  78. PEDICLE PUNCTURE 1: Where to touch the pedicle with the

    needle.
  79. PEDICLE PUNCTURE 2: Control in the middle of the pedicle.

    On A-P view, never cross the medial cortical of the pedicle until you have reached the posterior wall of the vertebral body on lateral view. ! !
  80. PEDICLE PUNCTURE 2: Control in the middle of the pedicle.

    On A-P view, never cross the medial cortical of the pedicle until you have reached the posterior wall of the vertebral body on lateral view. ! !
  81. PEDICLE PUNCTURE 3: Posterior wall, entering the vertebral body.

  82. PEDICLE PUNCTURE 3: Posterior wall, entering the vertebral body.

  83. PEDICLE PUNCTURE 4: Reaching the target.

  84. PEDICLE PUNCTURE 4: Reaching the target.

  85. PEDICLE PUNCTURE 4: Reaching the target.

  86. BI-PEDICULAR PUNCTURE 5: Two targets on both sides of sagittal

    midline. Antero- posterior situation remains the same.
  87. BI-PEDICULAR PUNCTURE 5: Two targets on both sides of sagittal

    midline. Antero- posterior situation remains the same.
  88. BI-PEDICULAR PUNCTURE 5: Two targets on both sides of sagittal

    midline. Antero- posterior situation remains the same.
  89. EXAMPLES Few millimeters shift of pedicle entering point. Note the

    consequences on target location. ! !
  90. EXTRA-PEDICULAR PUNCTURE 1: Where to touch the vertebra with the

    needle. Place the needle above the transverse process, to touch the vertebral body close to the pedicular origin.
  91. EXTRA-PEDICULAR PUNCTURE 1: Where to touch the vertebra with the

    needle.
  92. EXTRA-PEDICULAR PUNCTURE 1: Where to touch the vertebra with the

    needle.
  93. EXTRA-PEDICULAR PUNCTURE 2: Control at the medial cortical of the

    peduncle.
  94. EXTRA-PEDICULAR PUNCTURE 2: Control at the medial cortical of the

    peduncle.
  95. EXTRA-PEDICULAR PUNCTURE 3: Reaching the target.

  96. EXTRA-PEDICULAR PUNCTURE 3: Reaching the target.

  97. EXAMPLES - More difficult to reach the midline of the

    vertebra. - More risky for extra-vertebral cement leakage. ! !
  98. DORSAL PUNCTURE 1: Where to touch the vertebra with the

    needle. Extra-pedicular way between the transverse process and the posterior arch of the rib.
  99. DORSAL PUNCTURE 1: Where to touch the vertebra with the

    needle. Extra-pedicular way between the transverse process and the posterior arch of the rib.
  100. DORSAL PUNCTURE 1: Where to touch the vertebra with the

    needle.
  101. DORSAL PUNCTURE 1: Where to touch the vertebra with the

    needle.
  102. DORSAL PUNCTURE 2: Control at the medial cortical of the

    peduncle.
  103. DORSAL PUNCTURE 3: Reaching the target.

  104. DORSAL PUNCTURE 3: Reaching the target.

  105. EXAMPLES Pedicular approach is possible, depending on morphological aspect of

    the pedicles. ! !
  106. USING THE BEVEL Two differents aspects of the bevel: -

    the tip: instant and agressive puncture. - the plane: sliping and safe progression.
  107. USING THE BEVEL The plane of the bevel affects the

    course of the needle ! !
  108. USING THE BEVEL SAFE DANGEROUS !

  109. USING THE BEVEL The plane of the bevel affects the

    course of the cement ! !
  110. MISTAKES Are you safe?

  111. MISTAKES Are you safe?

  112. MISTAKES Are you safe? ! Intra-dural

  113. USING THE BEVEL Be aware of the « Champagne cork

    effect » ! ! ! INJECTION PRESSURE INJECTION PRESSURE
  114. MISTAKES Are you safe?

  115. MISTAKES Are you safe?

  116. MISTAKES Are you safe? ! Too lateral

  117. Vertebroplasty : technical aspects Monopedicular approach Needle placement

  118. Vertebroplasty : technical aspects Monopedicular approach Control of cast on

    CT scan Needle placement
  119. Vertebroplasty : technical aspects Needle placement

  120. Vertebroplasty : technical aspects Needle placement

  121. Vertebroplasty : technical aspects Needle placement

  122. Vertebroplasty : technical aspects Needle placement

  123. Vertebroplasty : technical aspects Needle placement

  124. None
  125. STOP injection during 20 sec. Watch posterior part of the

    vertebra…. to avoid this….. Vertebroplasty : technical aspects But sometimes can not be prevented Cement leakage : what to do ?
  126. None
  127. Vertebroplasty : technical aspects Cement leakage Lateral leakage : foraminal

    or paravertebral veins ….VCI….. Lungs !!
  128. Vertebroplasty : technical aspects Cement leakage Cement reflux along needle

    path : Wait 1 or 2 minutes before needle retrieval
  129. INCIDENTS : FUITES

  130. FUITE DISCALE

  131. CAS 8 Fuite veineuse minime

  132. FUITE EPIDURALE

  133. COMPLICATION : E. P.

  134. Interêt d’un biplan ?

  135. Vertebroplasty : Clinical results on osteoporotic fracture Clinical efficacy (personnal

    data ): Immediate pain relief in 45 % of cases After one Month : Significant pain relief in 80% of cases (EVA inferior to 3) Causes of inefficacy of vertebroplasty : Delay between fracture and treatment Better results if treated before 3 months Persistant pain due to induced by kyphosis 24° Treat patients early During firsts weeks Clinical improvement in 60 – 90 % of cases (Kallmes 2003, Peh2003, Cyteval 1999)
  136. FRACTURED OR NON FRACTURED : Primary tumor or metastasis Always

    perform biopsy before vertebroplasty Vertebroplasty can be done in the same time Multiple myeloma Breast, lung or kydney cancer Vertebroplasty : indications and selection of patients
  137. Importance of needle placement FRACTURED OR NON FRACTURED : Primary

    tumor or metastasis Vertebroplasty : indications and selection of patients
  138. Importance of needle placement Monopedicular approach Left side FRACTURED OR

    NON FRACTURED : Primary tumor or metastasis Vertebroplasty : indications and selection of patients
  139. Importance of needle placement Monopedicular approach Left side FRACTURED OR

    NON FRACTURED : Primary tumor or metastasis Vertebroplasty : indications and selection of patients
  140. Importance of needle placement Monopedicular approach Left side Right monopedicular

    Cranio-Caudal trajectory FRACTURED OR NON FRACTURED : Primary tumor or metastasis Vertebroplasty : indications and selection of patients
  141. Importance of needle placement Needle placement under CT scan or

    CT fluoroscopy if available FRACTURED OR NON FRACTURED : Primary tumor or metastasis Vertebroplasty : indications and selection of patients Couplage CT / scopie
  142. None
  143. Vertebroplasty : Clinical results on tumoral lesions FRACTURED OR NON

    FRACTURED : Primary tumor or metastasis
  144. Vertebroplasty : Clinical results on tumoral lesions FRACTURED OR NON

    FRACTURED : Primary tumor or metastasis
  145. Vertebroplasty : Clinical results on tumoral lesions FRACTURED OR NON

    FRACTURED : Primary tumor or metastasis
  146. Vertebroplasty : Clinical results on tumoral lesions FRACTURED OR NON

    FRACTURED : Primary tumor or metastasis
  147. None
  148. CAS 10 MYELOMA antérior approach.

  149. METASTASE from a breast cancer

  150. Vertebroplasty . The limits ? posterior wall ?

  151. Limites suites ..

  152. Vertebroplasty : Clinical results on tumoral lesions Excellent results on

    pain and on quality of life 60 to 90 % of significant pain release Weill in Radiology 1996 (241-247) ; Kaemmerlen NEJM 1989 (121-128) FRACTURED OR NON FRACTURED : Primary tumor or metastasis Significant increasing of Karnoffsky index Significant decrease in analgesics and morphinic demand
  153. Mme D. Vertebra plana

  154. First use of a High viscosity cement

  155. None
  156. None
  157. Hemangiomas are benign lesions Observed in 60 % of patients

    after 60 years old Symptomatic in 0,9 to 1,2 % (N’Guyen 1997 Surg. neurol. 391-397) Aggresssive hemangiomas described by Laredo in Radiology 1986 (183-189) FRACTURED OR NON FRACTURED :HEMANGIOMAS Vertebroplasty : indications and selection of patients Standard lesion : non symptomatic
  158. FRACTURED OR NON FRACTURED :AGGRESSIVE HEMANGIOMAS Vertebroplasty : indications and

    selection of patients Posterior arch involvement Epidural space extension Compression fracture is very rare
  159. FRACTURED OR NON FRACTURED :AGGRESSIVE HEMANGIOMAS Vertebroplasty : indications and

    selection of patients Complete filling of vertebral body due to hypervascularization Need higher volume of cement 7 – 8 ml / 3-5 ml in osteoporosis
  160. FRACTURED OR NON FRACTURED :AGGRESSIVE HEMANGIOMAS Vertebroplasty : indications and

    selection of patients Local targeted filling if hemangiomas limited to posterior arch
  161. Brunot in J Radiol 2005 (86) 41-5. 19 patients ,

    mean f.u. : 37 months Pain release in 15/16 patients 56% totally asymptomatic at f.u. 31 % slightly symptomatic but no need for chronic use of antalgics 16 symptomatic and 3 preventive vertebroplasty 3 patients treated preventively did not develop symptoms or fractures after treatment Vertebroplasty : Clinical results on aggressive hemangiomas
  162. Vertebroplasty : new trends Phosphocalcic cements : until soon not

    possible to inject through standard needle. New cements coming soon…. New indications : Burst Fractures : very promising results from personnal datas. Allows quick walk and prevents from delayed cyphosis Kyphoplasty : Can be used for kyphosis resisting to orthopedic positionning of the patient during vertebropalsty
  163. Magerl classification Traumatologie A 1 A2 A3

  164. 2002-2007 We have teated 130 Patients

  165. Sudden refracture after surgery or Orthopédic Tt. 1 month 2

    months Case n° 1 58 Y.O. M Obese Falling from a ladder
  166. Sudden refracture after surgery or Orthopédic Tt. 1 month 2

    months Case n° 1 58 Y.O. M Obese Falling from a ladder
  167. Case n°1 . Before- Vertebroplasty Post -Vertebroplas

  168. Refracture after osteosynthesis. Case n° 2 1 month 2 months

    66 Y.O M =//= L1 Car Injury
  169. Refracture after osteosynthesis. Case n° 2 1 month 2 months

    66 Y.O M =//= L1 Car Injury
  170. Case n° 2

  171. Cas n° 6 52 Y.O. F L2 A3 Car accident

    Cocaïne abuse
  172. Case ° 5 . F. 66 ans .Falling from a

    roof Th12. A1..Thrombo-embol.disease
  173. Scalable Fractures A 1

  174. When is the best moment to treat ? D1 D

    15 JD30 M2
  175. None
  176. Surgery alone was the bad choice 2 Months latter A2

  177. Short surgical fixation Seesaw falling . 17 Y o F

    . Spinal cord contusion. Laminectomy . Residual pain .
  178. Surgery + Vertebroplasty 3 Days after surgery 2 Months after

    vertebroplasty
  179. A2 butterfly like fracture

  180. Standing position

  181. None
  182. None
  183. Schmorl nodes

  184. None
  185. Osteoplasty or remodeling

  186. Kyphoplasty • The balloon is inserted through a small working

    canula.
  187. Kyphoplasty • The balloon is inserted through a small working

    canula.
  188. • The balloon is inflated, elevating the endplates and restoring

    vertebral body height
  189. • The balloon is inflated, elevating the endplates and restoring

    vertebral body height
  190. • The balloon is deflated and withdrawn, leaving a cavity

    within the vertebral body
  191. • The balloon is deflated and withdrawn, leaving a cavity

    within the vertebral body
  192. • The void is filled with a very thick bone

    cement under low pressure
  193. • The void is filled with a very thick bone

    cement under low pressure
  194. Post - Kypho

  195. « fresch» traumatic fractures < 8 Days

  196. None
  197. None
  198. None
  199. Kypho : X ray Result Pré Kypho Post Kypho

  200. Open Kyphoplasty in vertebral fracture

  201. Open Kyphoplasty in vertebral fracture

  202. End Thank You for your attention

  203. None
  204. Matériels cook les ciments

  205. Préparation. Injectabilité.radioopacité.plasticité

  206. None
  207. Relargage monomère volatile ?

  208. contrôle de la plasticité

  209. Les ballons de cyphoplasties

  210. Les Etudes / Polémiques.

  211. Critiques de ces études Faiblesse des effectifs « Tendance »

    NS à l’amelioration cte groupe V . Tendance inv. ds le groupe placebo Fausse multicentrique IRM non systématique ( fracture récente?) Délai non précisé ( =/= / inclusion ) Cross- over important ++ 13 G.
  212. VERTOS 1 : VERTOS 2

  213. Related Article by Weinstein, J. N. Related Article by Buchbinder,

    R. Related Article by Kallmes, D. F. PubMed Citation To the Editor: In the August 6 issue, Kallmes et al.1 report on the Investigational Vertebroplasty Safety and Efficacy Trial (ClinicalTrials.gov number, NCT00068822 [ClinicalTrials.gov] ), and Buchbinder et al.2 report on a randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640). We have serious concerns about both trials, which included patients with a duration of pain of up to 12 months. Vertebroplasty provides internal fixation of nonhealed osteoporotic vertebral fractures. It is well established that fixation of acute fractures elsewhere in the skeleton reduces fracture pain. Internal fixation of healed fractures is clearly . . . [Full Text of this Article] Réponse du 19 nov 2009
  214. Étude FREE ( Kypho)

  215. Les coûts Actes CCAM : 130 à 180 Euros (1

    ou 2 vertèbres) GHM : 1000 à 4000 Euros …(voir avec dim ..) Kit Kypho =//= de 3500 E Kit ? Vertebro 200 à 600 E Durée d’hospi nécessaire 1 à 2 jours =/=durée pour toucher le GHM
  216. Concurrence • Aiguilles • Ciment • Injecteur • Mélangeur

  217. Aiguilles - Cardinal Health - Arthro Care - Thiebaud -

    Mendec - Teknimed
  218. Ciments - Confidence - Biomet - Teknimed (opacity plus)

  219. Injecteurs - Thiebaud - Striker - Optimed - Cardinal -

    Biomet
  220. Injecteurs - Thiebaud - Striker - Optimed - Cardinal -

    Biomet
  221. Injecteurs - Thiebaud - Striker - Optimed - Cardinal -

    Biomet
  222. Mixeurs - Teknimed - Striker (2 en 1) - System

    D
  223. Questions diverses ..