Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.
-
Upload
angelique-bolling -
Category
Documents
-
view
220 -
download
2
Transcript of Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.
![Page 1: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/1.jpg)
Radiology
June 15th 2013Sofitel Hotel
Dr Paul O’Connell
![Page 2: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/2.jpg)
Radiology
• Imaging• Procedures
![Page 3: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/3.jpg)
Acute back pain
![Page 4: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/4.jpg)
You haven’t put your back out.You’ve tied your shoe lace to your cuff link again!
![Page 5: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/5.jpg)
Red Flagsindicators of possible serious spinal pathology
• Possible fracture Major trauma Minor trauma in elderly or osteoporotic
• Possible tumour or infection Age >50 or <20 years History of cancer Constitutional symptoms (fever, chills, weight loss) Recent bacterial infection IV drug use Immunosuppression Pain worsening at night or when supine
• Possible significant neurological deficit Severe or progressive sensory alteration or weakness Bladder or bowel dysfunction O/E neurological deficit (in legs or perineum in the case of low back pain)
![Page 6: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/6.jpg)
Red Flagsindicators of possible serious spinal pathology
• Possible fracture Major trauma Minor trauma in elderly or osteoporotic
• Possible tumour or infection Age >50 or <20 years History of cancer Constitutional symptoms (fever, chills, weight loss) Recent bacterial infection IV drug use Immunosuppression Pain worsening at night or when supine
• Possible significant neurological deficit Severe or progressive sensory alteration or weakness Bladder or bowel dysfunction O/E neurological deficit (eg legs or perineum)
![Page 7: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/7.jpg)
• pain radiating into the limb in dermatome– lancinating, burning, stabbing, or electric quality
• limitation of straight-leg-raise to <300
• CT or MRI to assess for disc herniation – at segmental level consistent with clinical features
Acute radicular pain
![Page 8: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/8.jpg)
Well, if you insist on a second opinion:Then I’d say ….. it ISN’T sciatica.
![Page 9: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/9.jpg)
Acute radicular pain
![Page 10: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/10.jpg)
![Page 11: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/11.jpg)
Transforaminal nerve root block
![Page 12: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/12.jpg)
Disc protrusionSubarticular (posterolateral)
![Page 13: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/13.jpg)
GP MRI referralUnder 16 years of age• Head – unexplained seizure(s)– unexplained headache where significant pathology suspected– paranasal sinus disease not responded to conservative
therapy
• Spine (following radiographic examination) – significant trauma– unexplained neck or back pain with associated neurology
signs– unexplained back pain if significant pathology suspected
![Page 14: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/14.jpg)
GP MRI referralUnder 16 years of age for:• Knee (following radiographic examination)
– for internal joint derangement
• Hip (following radiographic examination) – suspected septic arthritis– suspected slipped capital femoral epiphysis– suspected Perthes disease
• Elbow (following radiographic examination) – suspected significant fracture or avulsion injury
• Wrist (following radiographic examination) – scaphoid fracture is suspected
![Page 15: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/15.jpg)
GP MRI referral
From 1 November 2013 GPs will be able to request MRIs for all patients over 16 years for clinically appropriate indications
![Page 16: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/16.jpg)
![Page 17: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/17.jpg)
Disc protrusion
![Page 18: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/18.jpg)
Spine MRI nomenclature
• Problem: too many terms• Combined task force– North American Spine Society– American Society of Spine Radiology– American Society of Neuroradiology
• Produce definitions
Spine 2001; 26 (5): E93-E113
![Page 19: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/19.jpg)
![Page 20: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/20.jpg)
Annular Tear
![Page 21: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/21.jpg)
![Page 22: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/22.jpg)
![Page 23: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/23.jpg)
![Page 24: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/24.jpg)
![Page 25: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/25.jpg)
![Page 26: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/26.jpg)
![Page 27: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/27.jpg)
![Page 28: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/28.jpg)
![Page 29: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/29.jpg)
![Page 30: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/30.jpg)
![Page 31: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/31.jpg)
![Page 32: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/32.jpg)
![Page 33: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/33.jpg)
![Page 34: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/34.jpg)
![Page 35: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/35.jpg)
![Page 36: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/36.jpg)
![Page 37: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/37.jpg)
![Page 38: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/38.jpg)
Sequestered disc fragment
![Page 39: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/39.jpg)
Sequestered fragment
![Page 40: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/40.jpg)
Location of herniation
![Page 41: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/41.jpg)
Central disc protrusion
![Page 42: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/42.jpg)
Subarticular disc protrusion
![Page 43: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/43.jpg)
Foraminal disc protrusion
![Page 44: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/44.jpg)
Extraforaminal disc protrusion
![Page 45: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/45.jpg)
Resorption of herniation
![Page 46: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/46.jpg)
C3
C4
C5
C6
C7
T1
Disc osteophyte complex
![Page 47: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/47.jpg)
Degenerative endplates
![Page 48: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/48.jpg)
• Modic classification– 1 oedema
– Can simulate infection
– 2 fat
– 3 sclerosis
Associated with disc pathology / instabilityModic 1 (& 2) may be associated with pain
Degenerative endplates
![Page 49: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/49.jpg)
Modic 1
![Page 50: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/50.jpg)
Evolution of Modic change
Modic 1
Modic 2
![Page 51: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/51.jpg)
![Page 52: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/52.jpg)
![Page 53: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/53.jpg)
Modic 1
![Page 54: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/54.jpg)
SpondylolisthesisPars defect L5
T1 sagittalright
T2* sagittalright
![Page 55: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/55.jpg)
• Management of– Acute radicular pain– Chronic low back pain• Facetal• Sacro-iliac joint
– Cervicogenic headaches– Osteoporotic crush fracture– Hypotension headaches
Image guided treatment for back pain
![Page 56: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/56.jpg)
No no!! Not that one…. The BIG one on the top shelf!!
![Page 57: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/57.jpg)
BMJ article 2008• Sciatica from disc herniation - conservative versus surgery• Outcomes at 1 and 2 years were similar for 283 patients• No clinically significant difference 8 wks & 6 months’ follow-up• 56% of patients did not require surgery for recovery.• Early surgery roughly doubled the speed of recovery• Delayed surgery might result in some extra weeks of discomfort• Major advantage of early surgery
– more rapid relief of pain– reassurance about recovery– earlier return to normal activities
Sciatica caused by lumbar disc herniation conservative care versus early surgery2 year results of a randomised controlled trial
BMJ ; June 2008
Department of Neurosurgery, Leiden University Netherlands.
![Page 58: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/58.jpg)
Pain Medicine article 2010
• Transforaminal injection of steroids a viable alternative to surgery for lumbar radicular pain due to disc herniation.
• 150 patients randomised into test groups• 54% relief at 1 month (>50% reduction of pain)
• 25% relief at 1 year (after 1 injection)
• Acute & chronic radiculopathy
Transforaminal Steroid Injection for Lumbar Radicular Pain Superior to PlaceboPain Medicine August 2010 Bogduk et al
![Page 59: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/59.jpg)
Pain nerve
Motor nerve
Local anaesthetic needs to cover ≥3 nodes of Ranvier
![Page 60: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/60.jpg)
• Acute disc protrusion→annular nerve ending pain (+/- referred pain)
• Mechanical compression / stretch of spinal root→weakness and numbness
• uninflamed nerve compressed will stop functioning
• 20 inflammation→radicular pain
Radiculopathy usually recovers 2-6 weeks but disc resorption takes monthsSurgical decompression does not always relieve radiculopathy
McLain et alCleveland Clinic J Medicine 71:12 Dec 2004
Disc Protrusion
![Page 61: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/61.jpg)
Injury
Phospholipase A2
Arachidonic acid
Cyclooxygenase Lipooxygenase
Hyperalgaesic Prostoglandins Hyperalgaesic leukotrines& thromboxanes
Inflammation & pain
Inflammatory cascade
NSAIDSTEROID
![Page 62: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/62.jpg)
Perineural injection L5 Perineural injection S1
![Page 63: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/63.jpg)
Epidural steroid injection
![Page 64: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/64.jpg)
Sacro–iliac joint injection
![Page 65: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/65.jpg)
Facet injection - cervical
![Page 66: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/66.jpg)
Radiofrequency of “medial branch”
![Page 67: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/67.jpg)
![Page 68: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/68.jpg)
Cervicogenic pain
Greater occipital nerve
Lesser occipital nerve
Third occipital nerve
![Page 69: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/69.jpg)
Radiofrequency ablation C2/3 & C3/4
![Page 70: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/70.jpg)
Greater occipital nerve block
![Page 71: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/71.jpg)
Osteoporotic crush fractures
![Page 72: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/72.jpg)
![Page 73: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/73.jpg)
![Page 74: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/74.jpg)
Vertebroplasty
![Page 75: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/75.jpg)
VertebroplastyThe New England Journal of Medicine in 2009
• 2 studies found no benefit for compression fractures compared to sham procedure
– Kallimes University of Washington• multicenter, prospective double-blinded randomized trial• 131 participants • vertebroplasty had no detectable benefit from sham procedures.
– Buchinder trial• funded by the Australian government and Cook Medical Inc• Multicenter, randomized, double-blind, placebo-controlled trial• 78 participants with osteoporotic vertebral compression fractures• vertebroplasty and sham procedures nearly identical pain relief
![Page 76: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/76.jpg)
• Osteoporotic crush fractures usually heal 6-12 weeks• Suggest perform vertebroplasty < 6 weeks– Or if fracture / fluid filled cleft persists > 6weeks
• Buchinder study– trial average 9.5 weeks (up to 12 months)– MRI oedema = fracture (may persist for months after union)
• Kallimes study– 18 weeks average– No MRI or nuclear medicine required
VertebroplastyMedical Journal of Australia 2010 – reply Clarke et al
![Page 77: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/77.jpg)
VertebroplastyMedical Journal of Australia 2010 – Clarke et al
Persisting vertebral body fracture (Kummell’s disease)
![Page 78: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/78.jpg)
• Medicare response to NEJM articles
• USA 20/6/2011 in order to be reimbursable– 1) detailed medical record showing pain caused by fracture– 2) radiographic confirmation of a fracture– 3) other treatment plans attempted for a reasonable time– 4) procedure not performed in the emergency department– 5) that at least 1 year of follow-up
• Australia 1st November 2011– Removes vertebroplasty from MBS
Vertebroplasty
![Page 79: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/79.jpg)
CSF Hypotension Headache
![Page 80: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/80.jpg)
![Page 81: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/81.jpg)
![Page 82: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/82.jpg)
![Page 83: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/83.jpg)
Something, somewhere, went terribly wrong
![Page 84: Radiology June 15 th 2013 Sofitel Hotel Dr Paul O’Connell.](https://reader031.fdocuments.in/reader031/viewer/2022012922/551b4046550346ae7a8b49b5/html5/thumbnails/84.jpg)
Thank you
Something, somewhere, went terribly wrong