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Ankle and/or pantalar arthrodesis was performed between January 1994 and March 1999 with a composite type of Ilizarov fixation in 21 patients (age 18–82 years). Indications for ankle arthrodesis by composite fixation were: a failed fusion after primary arthrodesis by internal methods (six cases), septic conditions after failed internal fixation of tibia plafond fractures (five cases), primary fracture treatment after talus or tibia plafond fractures (three cases) and primary arthrodesis as a result of poor soft tissue conditions after open surgery (seven cases). In all patients a successful fusion of the affected joint was achieved by composite fixation without a change in the treatment plan. Composite fixation represents a minimal invasive, safe and successful method for arthrodesis of the ankle and subtalar joint. Particularly after failed arthrodesis, difficult post-traumatic conditions, infection, osteoporosis or other soft tissue problem, it seems to be an efficacious tool to prevent amputation in these special cases. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long‐term outcomes of 37 patients with 60 osteoporotic vertebral fractures, located in the thoracic and lumbar spine, treated with balloon kyphoplasty.Material and Methods: Fourty‐two patients (15 males and 27 females) with 67 osteoporotic vertebral fractures were treated with balloon kyphoplasty. We were able to have 2‐year follow‐up of 37 patients with 60 treated vertebrae. Baseline fracture rate in these 37 patients was 1.9 (60 fresh fractures and 11 old fractures already healed). Symptomatic levels were identified by correlating the clinical presentation with conventional radiographs, computed tomography (CT), and/or magnetic resonance imaging (MRI). During the 2‐year follow‐up, reduction in pain was determined. The effects on pain symptoms were measured on a self‐reported visual analog scale (VAS) and the Oswestry score was documented to assess disability. Radiographic scans were performed pre‐ and postoperatively, and after 3, 6, 12, and 24 months. The vertebral height and endplate angles were measured to assess the restoration of the sagittal alignment.Results: The median pain scores (VAS) decreased significantly from pre‐ to post‐treatment as did the Oswestry Disability Score (P<0.05). This improvement was maintained at 2‐year follow‐up. In eight patients (21.6%) (five female, three male), an adjacent fracture occurred in 11 vertebrae (18.3%) within 3 weeks to 22 months of follow‐up (after 22 months no adjacent fracture occurred). This makes an annualized refracture rate of 10% (18.3/22×12). In three patients the adjacent fractures were asymptomatic. Five patients with symptomatic adjacent fractures (eight vertebrae) wanted to be treated again with balloon kyphoplasty. Clinically asymptomatic cement leakage occurred in nine of 67 vertebral bodies (13.4%). During 2‐year follow‐up, this surgical technique demonstrated restoration and stabilization of the height of the vertebral body.Conclusion: Balloon kyphoplasty is an effective, minimally invasive procedure for the stabilization of osteoporotic vertebral fractures, leading to a statistically significant reduction of pain status. [ABSTRACT FROM AUTHOR]

There is currently little data on the longer term efficacy and safety of balloon kyphoplasty (BKP) in patients with metastatic vertebral compression fractures (VCFs). To prospectively assess the long-term efficacy and safety of BKP in treating thoracic and lumbar spinal metastatic fractures that result in pain or instability. Sixty-five patients (37 men, mean age: 66 years) underwent 99 BKP procedures. Patient-related outcomes of pain visual analogue scale (VAS) and Oswestry Disability Index were assessed pre- and post-operatively and after 3, 6, 12 and 24 months. Correction of vertebral height and kyphotic deformity were assessed by radiographic measurements. Mean pain VAS and Oswestry Disability Index significantly improved from pre- to post-treatment ( P < 0.0001), this improvement being sustained up to 24-month follow up. A gain in height restoration and a reduction of the post-operative kyphotic angle were seen post-operatively and at 3 months although these radiographic outcomes returned to pre-operative levels at 12 months. BKP was associated with a rate of cement leakage and incidence vertebral fracture of 12 and 8%, respectively. No symptomatic cement leaks or serious adverse events were seen during the 24 months of follow up. BKP is a minimally invasive procedure that provides immediate and long-term pain relief and improvement in functional ability in selected patients with metastatic VCFs. The procedure appears to have good long-term safety. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate in a prospective study the clinical and radiographic outcome of vertebroplasty in patients with osteolytic lesions of the cervical spine caused by multiple myeloma. Material and Methods: Pathological vertebral fractures associated with multiple myeloma were treated in five patients. Vertebroplasty was performed in 12 vertebral bodies. Symptomatic levels were identified by correlating the clinical presentation with magnetic resonance imaging (MRI), conventional radiographs, and computed tomography (CT). During the 12-month follow-up, pain symptoms were measured on a self-reported visual analog scale (VAS), neck pain disability index (NPDI, range 0-100%), and cervical spine functional score (CSFS, range 0-100). Medical imaging was performed pre- and postoperatively and after 3, 6, and 12 months. The vertebral height was measured to assess the restoration of the sagittal alignment. Results: The median pain scores (VAS) as well as the NPDI and CSFS decreased significantly after vertebroplasty (P<0.05). Cement leakage occurred in two of 12 vertebral bodies (16.6%), without clinical relevance. The vertebral body height was stabilized during follow-up. Conclusion: Vertebroplasty in the cervical spine is an effective open surgical procedure for the stabilization of pathological vertebral fractures caused by multiple myeloma leading to a statistically significant reduction of pain status. Vertebral body height is stabilized and further deformities are avoided. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical and radiographic outcomes of balloon kyphoplasty in patients with fractures of the thoracic and lumbar spine caused by multiple myeloma. Material and Methods: Vertebral fractures due to multiple myeloma were treated by balloon kyphoplasty (20 patients, 48 vertebral bodies). Symptomatic levels were identified by clinical presentation, magnetic resonance imaging (MRI), radiographs, and computed tomography (CT). During the following year, visual analog scale (VAS) and Oswestry disability score were documented. Radiographs were taken pre- and postoperatively at 3, 6, and 12 months. Vertebral height and kyphotic deformity were measured to assess restoration of the sagittal alignment. Results: The median pain scores (VAS) decreased significantly from pre- to posttreatment, as did the Oswestry disability score (p < 0.05). Clinically asymptomatic cement leakage occurred at 5 fracture levels (10.4%). During 1-year follow-up, this surgical technique demonstrated restoration and stabilization of the height of the vertebral body. Conclusion: Balloon kyphoplasty is an effective minimally invasive procedure for stabilizing pathological vertebral fractures caused by multiple myeloma and leading to a statistically significant reduction of pain status. Balloon kyphoplasty stabilizes the vertebral body height, but is only partially able to prevent further kyphotic deformities. [ABSTRACT FROM AUTHOR]