Ebook Women’s health in interventional radiology: Part 2
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Ebook Women’s health in interventional radiology: Part 2
Part IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2Karajgikar, and Wayne J. OlanIntroductionInterventional Radiology has played an increasingly critical role in the arena of women’s health. Specifically in the spine, image-guided interventions consist primarily of vertebroplasty, kyphoplasty, spine biopsy, and pain management. The evolution of verte Ebook Women’s health in interventional radiology: Part 2broplasty and kyphoplasty have changed the management of osteoporotic and malignant vertebral body compression fractures (VCFs), This chapter will disEbook Women’s health in interventional radiology: Part 2
cuss each intervention, with particular emphasis given to step-by-step descriptions of the procedures.PathophysiologyAn estimated 700,000 vertebral coPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2 age of 50 have a 26% chance of having a vertebral compression fracture. This incidence increases with age, climbing to 40% in women over the age of 80. Women who have sustained a previous vertebral fracture have a 19.2% chance of developing new fractures in the following year [ 1 ].The majority of Ebook Women’s health in interventional radiology: Part 2vertebral insufficiency across both genders stems from osteoporosis. Consequently, approximately 70% (68.9%) of back pain associated w ith vertebral cEbook Women’s health in interventional radiology: Part 2
ompression fractures is due to osteoporosis. Other less common causes of vertebral compression fractures include metastatic cancer (20.4% of fracturesPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2ot available, it is believed that at least one half of all individuals who die from cancer each year have skeletal metastases. The medical, economic, and social consequences of breast cancer metastasis to the spine can be more severe than any other cause of VCF. In women, breast cancer is the most l Ebook Women’s health in interventional radiology: Part 2ikely malignancy to metastasize to bone [3,4]. Just like any other vertebral fracture, a spine metastasisA.c. Venbrux(El)Department of Radiology. DiviEbook Women’s health in interventional radiology: Part 2
sion of Interventional Radiology,The George Washington University Medical Center, Washington, DC. USA e-mail: avenbnix@mfa.gwu.eduE.A. Ignacio and A.cPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2There is osteopenia and loss of height in the L2 vertebral bodyfracture has the potential to induce great pain and cause spinal cord compression, among other problems. However, metastasized breast cancer cells create a higher propensity for vertebral compression fracture by promoting osteoclast form Ebook Women’s health in interventional radiology: Part 2ation, resulting in increased bone resorption. In turn, this increased bone resorption can lead to severe and potentially fatal hypercalcemia.It is imEbook Women’s health in interventional radiology: Part 2
portant to note that while spine metastases due to breast cancer are usually osteolytic lesions, osteoblastic activity can also be present and is predPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2f the SpineThere are 7 cervical (C1-C7), 12 thoracic (T1-T12), 5 lumbar (L1-L5), 5 sacral (S1-S5), and 3-5 coccygeal vertebrae (Fig. 5.2a-d). The sacral and coccygeal vertebrae are fused, while the superior 24 are moveable to varying degrees and arc separated by intervertebral5Kyphoplasty and Vei te Ebook Women’s health in interventional radiology: Part 2bioplasty109disks. The cervical spine and the lumbar spine maintain a slight lordotic curvature, while the thoracic and sacral portions of the spine tEbook Women’s health in interventional radiology: Part 2
ypically maintain a slight kyphotic angulation. See Fig. 5.2a-d.rhe cervical spine is distinguished by two unique vertebrae, the “atlas” (Cl) and the Part IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2ossess a transverse foramen. Thoracic vertebrae are intermediate in size and are distinguished by the presence of costal facets tbr articulation with the ribs. The five lumbar vertebrae arc the largest and possess none of the above features. From a practical standpoint, the pedicles of the lumbar ve Ebook Women’s health in interventional radiology: Part 2rtebral bodies are angulated more posterolat-crally than in the thoracic spine and thus require a more oblique positioning in order to be visualized oEbook Women’s health in interventional radiology: Part 2
n fluoroscopy. The pedicles of the lumbar vertebral bodies are also the thickest and are thus the least challenging to cannulate. Performing spinal auPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2 less common than in the lower thoracic and lumbar spine.Variants, such as the presence of four or six lumbar-type vertebral bodies (formed when the 1.5 is fused with the sacrum, known as sacralization of 1,5) and underdevelopment of the 12th ribs, are fairly common. This may lead to confusion durin Ebook Women’s health in interventional radiology: Part 2g reporting of the imaging studies, where the level of injury may be misrepresented, rhe authors therefore advocate counting the vertebrae under direcEbook Women’s health in interventional radiology: Part 2
t fluoroscopic observation prior to performing any spinal intervention in order to ensure that the procedure is performed at the correct spinal level.Part IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2oplasty and kyphoplasty. This includes any radiographs, magnetic resonance imaging (MR1) scans, and computed tomography (CT) scans.Classic findings suggestive of a VCF on radiographs include loss of vertebral body height at the superior and/or inferior vertebral end plates. There is often a wedge ap Ebook Women’s health in interventional radiology: Part 2pearance from more narrowing and loss of height anteriorly (Fig. 5.1). Radiographs or plain films can also be taken with the patient in different posiEbook Women’s health in interventional radiology: Part 2
tions to assess the mobility of the vertebrae. However, the relative age of the fracture cannot be determined from spine radiographs.Characterization Part IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2ures, and differentiating which fracture is responsible for their present symptoms is crucial.MRI is superior in detailing the vertebral anatomy as well as demonstrating marrow signal changes in order to determine the age of the fracture. Sagittal T2-weighted images and short 11 inversion recovery ( Ebook Women’s health in interventional radiology: Part 2STIR) sequences arc particularly useful in identifying fluid and edema, and thus distinguishing between acute, subacute, and chronic fractures (Fig. 5Ebook Women’s health in interventional radiology: Part 2
.3). Acute and subacute fractures that arc less than 1 month old will have hypointense T1 signal and hyperintense T2 signal. As the VCF heals, the marPart IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay K Ebook Women’s health in interventional radiology: Part 2images, indicating bony fibrosis and/or bony sclerosis. Stallmeycrcl al. recommends obtaining a CT scan for confirmation of bony sclerosis, as cement injection here would be nearly impossible 171. Ebook Women’s health in interventional radiology: Part 2Part IIISpine InterventionsKyphoplasty and VertebroplastyJozef M. Brozyna, Denis Primakov, Anthony c. Vcnbrux, Ajay D. Wadgaonkar, Sarah LaFond, Jay KGọi ngay
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