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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Ranc PA, Rudel A, Bentellis I, Prestat A, Elbaze S, Sala V, Torre F, Pavan LJ, Uri IF, Amoretti N. Patient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study. J Vasc Interv Radiol 2024; 35:390-397. [PMID: 38110149 DOI: 10.1016/j.jvir.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of percutaneous lumbar discectomy (PLD) under computed tomography (CT) guidance on pain and functional capacities and to estimate the speed of recovery by assessing the time to return to work. MATERIALS AND METHODS Patients treated with PLD were prospectively included between December 2019 and April 2021. Data regarding pain, duration of symptoms, analgesia intakes, time of absence from work, and the Oswestry disability index (ODI) were collected. Patients were followed-up during 6 months. Duration of hospitalization and time to return to work were reported. The Fisher test was used to compare nominal variables, the Kruskal-Wallis test to compare ordinal variables, and the Student t test to compare quantitative continuous variables. RESULTS A total of 87 patients were evaluated (median age, 56 years; interquartile range [IQR], 43-66 years). The median ODI decreased from 44 (IQR, 33-53) to 7 (IQR, 2-17) at 6 months (P < .001). The median visual analog scale score decreased from 8 (IQR, 8-9) to 2 (IQR, 0-3) within 6 months (P < .001). In total, 96.5% of patients were discharged on the day of the procedure, and 3.5% were discharged on the following day. No severe adverse events were reported according to the Society of Interventional Radiology (SIR) classification system. Of the 57 patients previously employed, 50 were able to return to work during the follow-up, with a median time of 8 days (IQR, 0-20 days). CONCLUSIONS Symptomatic lumbar disc herniation can be successfully treated using PLD, resulting in significant improvement in symptoms and functional capacities and a fast return to work.
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Affiliation(s)
- Paul-Alexis Ranc
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France.
| | - Alexandre Rudel
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Imad Bentellis
- Urological Surgery Department, Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Alexandre Prestat
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Simon Elbaze
- Radiology Department, Hôpital Raymond Poincaré, Garches, France
| | - Vincent Sala
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Federico Torre
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Luca-Jacopo Pavan
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Ishaq Fahmi Uri
- Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Nicolas Amoretti
- Radiology Department Centre Hospitalier universitaire de Nice, Hôpital Pasteur 2, Nice, France
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Amoretti N, Burns R, Ranc PA, Elbaze S, Sala V, Pavan LJ, Torre F, Rudel A, Kelekis A. Intervertebral Body Implant Salvage: Stabilization by Bone Augmentation. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03480-4. [PMID: 37316695 DOI: 10.1007/s00270-023-03480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Affiliation(s)
| | - Robert Burns
- Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Paul-Alexis Ranc
- Centre Hospitalier Universitaire Pasteur 2, 06000, Nice, France.
| | - Simon Elbaze
- Hôpital Raymond Poincaré, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Vincent Sala
- Centre Hospitalier Universitaire Pasteur 2, 06000, Nice, France
| | | | - Federico Torre
- Centre Hospitalier Universitaire Pasteur 2, 06000, Nice, France
| | - Alexandre Rudel
- Centre Hospitalier Universitaire Pasteur 2, 06000, Nice, France
| | - Alexis Kelekis
- Imaging and Research Unit, Second Department of Radiology, Evgenidion Hospital, University of Athens, Athens, Greece
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Pavan LJ, Dalili D, Ranc C, Torre F, Clerk-Lamalice O, Burns R, Andreani O, Ranc PA, Bronsard N, Prestat A, Amoretti N. Correction to: CT-Guided Percutaneous Vertebroplasty for Vertebral Non-union Following Posterior Fixation: A Preliminary Retrospective Study. Cardiovasc Intervent Radiol 2022; 45:720. [PMID: 35288771 DOI: 10.1007/s00270-022-03112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Luca Jacopo Pavan
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France.
| | - Danoob Dalili
- South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK.,Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, London, KT18 7EG, UK
| | - Caroline Ranc
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | - Federico Torre
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | | | - Robert Burns
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | - Olivier Andreani
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | - Paul Alexis Ranc
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | - Nicolas Bronsard
- Spine Surgery - University Institute of Locomotion and Sports, Nice University Hospital , Hôpital Pasteur 2, Nice, France
| | - Alexandre Prestat
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
| | - Nicolas Amoretti
- Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France
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Pavan LJ, Dalili D, Ranc C, Torre F, Clerk-Lamalice O, Burns R, Andreani O, Ranc PA, Bronsard N, Prestat A, Amoretti N. CT-Guided Percutaneous Vertebroplasty for Vertebral Non-union Following Posterior Fixation: A Preliminary Retrospective Study. Cardiovasc Intervent Radiol 2022; 45:687-695. [DOI: 10.1007/s00270-021-03037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
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Meunier R, Truchetet ME, Dallaudière B, Fournier C, Barnetche T, Amoretti N, Cornelis F, Hauger O. MRI and spondyloarthropathy: diagnostic performance compared to long-term clinical follow-up with evaluation of gadolinium chelates injection. Eur Radiol 2021; 32:1409-1418. [PMID: 34553254 DOI: 10.1007/s00330-021-08171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate MRI performance on both initial and long-term rheumatologic diagnosis of spondyloarthritis (SpA), taking into account clinical evolution and treatment response, and the impact of gadolinium injection. METHODS In this single-center study, patients who underwent both spinal and sacroiliac (SI) joint MRI were prospectively recruited between May 2013 and January 2014 and followed for 7 years until 2020. Clinical, biological, and radiologic parameters were collected. At 7-year follow-up (2020), two independent readers reevaluated the initial MRI datasets for specific radiological features of SpA with a 5-point Likert scale to record the estimation of confidence. The centralized MRI interpretations were compared to the established rheumatologic diagnoses in 2013 and 2020. RESULTS In total, 145 patients (52 men and 93 women) were included. During the 7-year follow-up, the number of patients with positive SpA diagnosis decreased from 93 to 58. Mean sensitivity, specificity, and accuracy of non-contrast MRI were 18, 97, and 49% and 27, 97, and 69% considering 2013 and 2020 rheumatologic diagnoses, respectively. Mean sensitivity, specificity, and accuracy values of gadolinium-enhanced MRI were 26, 97, and 54% and 38, 97, and 73% considering 2013 and 2020 diagnoses, respectively. Post-contrast MRI enabled identification of a subgroup of enthesis-only lesions, without any bone lesions, corresponding to 14% of the pathological cohort. It confirmed uncertain diagnoses in an additional 8.5% of pathological cases. CONCLUSIONS MRI performance for SpA diagnosis is higher when long-term clinical follow-up is considered than when compared to initial diagnosis. Gadolinium injection increases MRI diagnostic performance and may demonstrate a pure enthesic form of the disease, without bone abnormality. KEY POINTS • Compared to the rheumatologist's diagnosis over long-term clinical follow-up, MRI performance for SpA is higher than usually estimated. • Gadolinium injection increases diagnostic performance of MRI as it may identify a purely enthesis form of the disease. • Gadolinium injection should be discussed in patients for whom the diagnostic suspicion is strong and whose initial non-injected examination is normal or doubtful.
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Affiliation(s)
- Raphaëlle Meunier
- Service de Rhumatologie, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | | | - Benjamin Dallaudière
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Claire Fournier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Thomas Barnetche
- Service de Rhumatologie, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | | | - François Cornelis
- Service d'imagerie médicale, Hôpital Lariboisière, APHP, Paris, France
| | - Olivier Hauger
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.
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Amoretti N, Cervantes E, Stacoffe N, Foti P, Litrico S, Kastler A. Trans-isthmic pars interarticularis screw fixation under CT and fluoroscopic guidance: technical success and clinical outcome in patients with symptomatic low-grade lumbar isthmic lysis. Eur Radiol 2021; 31:8264-8271. [PMID: 33877386 DOI: 10.1007/s00330-021-07921-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the technical success of trans-isthmic screw fixation with simultaneous CT and fluoroscopic guidance in patients with symptomatic low-grade isthmic spondylolisthesis. METHODS Fifty patients (28 women and 22 men; mean age ± standard deviation: 50 years ± 18.9) presenting with symptomatic low back pain with isthmic spondylolisthesis refractory to medical management were treated by means of trans-isthmic pars interarticularis percutaneous screw fixation. The procedure was performed under local anesthesia with double CT and fluoroscopic guidance. Primary outcome was technical success of the procedure, which was assessed with a post-procedure CT using the same success criteria as surgical screw placement with regard to entry point, trajectory, and screw tip. Secondary outcome was pain decrease assessed by the Visual Analog Scale (VAS). RESULTS Ninety-nine procedures were performed in 50 patients and 99 screws were inserted. Postoperative CT assessment showed satisfactory screw placement in 96 cases, reflecting a technical success rate of 96.9%. No complications occurred during or after the procedure. Pain assessment showed a pain decrease of VAS score from a median of 7 (min 5, max 10; MAD 1.4) to 2 (p < 0.0001) (min 0, max 7, MAD 1.7) with a mean follow-up of 39 months. CONCLUSION Trans-isthmic screw fixation performed under CT and fluoroscopic guidance presents a high technical success and appears as a safe procedure and effective procedure in patients with symptomatic low-grade isthmic lysis. KEY POINTS • Trans-isthmic pars interarticularis percutaneous screw insertion is feasible under double CT and fluoroscopic guidance by a radiologist with a high technical success. • This technique can be performed under local anesthesia only. • In patients with chronic low back pain, isthmic screwing allows long-term pain improvement.
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Affiliation(s)
- Nicolas Amoretti
- Muskulo-Skeletal Radiology Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France
| | - Elodie Cervantes
- Muskulo-Skeletal Radiology Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France
| | - Nicolas Stacoffe
- Muskulo-Skeletal Radiology Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France
| | - Pauline Foti
- Muskulo-Skeletal Radiology Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France
| | - Stephane Litrico
- Neurosurgery Department, Pasteur II University Hospital Nice, 30 voie Romaine, Nice, France
| | - Adrian Kastler
- Interventional and Diagnostic Neuroradiology Unit, Grenoble University Hospital, Boulevard du Grésivaudan, 38000, Grenoble, France.
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8
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Amoretti N, Dalili D, Palominos D, Cornelis F, Theumann N, Cifrian-Perez M, Foti P, Rudel A, Olivier H, Gallo G. Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study. Neuroradiology 2021; 63:1135-1143. [PMID: 33783556 DOI: 10.1007/s00234-021-02633-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment. METHODS A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure. RESULTS Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers. CONCLUSION APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.
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Affiliation(s)
- Nicolas Amoretti
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France.
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Diego Palominos
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | | | - Nicolas Theumann
- Department of Radiology, Centre Hospitalier Universitaire de Lausanne, Lausanne, France
| | - Manuel Cifrian-Perez
- Department of Radiology, Micro Invasive Intervention, Valencia Hospital Universitario y Politecnico la Fe, Valencia, Spain
| | - Pauline Foti
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | - Alexandre Rudel
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
| | - Hauger Olivier
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Giacomo Gallo
- Department of Radiology, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 VoieRomaine, 06000, Nice, France
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9
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Prestat AJ, Dalili D, Rudel A, Torre F, Pavan LJ, Boileau P, Amoretti N. Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery? Eur Radiol 2020; 31:4221-4231. [PMID: 33201283 DOI: 10.1007/s00330-020-07463-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening. METHODS In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region. RESULTS All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations. CONCLUSION RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery. KEY POINTS • Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants. • Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life. • Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.
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Affiliation(s)
- A J Prestat
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.
| | - D Dalili
- Nuffield Orthopedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A Rudel
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.,Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - F Torre
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - L J Pavan
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - P Boileau
- Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - N Amoretti
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
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Trojani MC, Lamy B, Ruimy R, Amoretti N, Risso K, Roux C. An unusual Staphylococcus saccharolyticus spondylodiscitis post kyphoplasty: a case report. BMC Infect Dis 2020; 20:539. [PMID: 32703263 PMCID: PMC7379344 DOI: 10.1186/s12879-020-05263-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Staphylococcus saccharolyticus is a rarely encountered coagulase-negative, which grows slowly and its strictly anaerobic staphylococcus from the skin. It is usually considered a contaminant, but some rare reports have described deep-seated infections. Virulence factors remain poorly known, although, genomic analysis highlights pathogenic potential. Case presentation We report a case of Staphylococcus saccharolyticus spondylodiscitis that followed kyphoplasty, a procedure associated with a low rate but possible severe infectious complication (0.46%), and have reviewed the literature. This case specifically stresses the risk of healthcare-associated S. saccharolyticus infection in high-risk patients (those with a history of alcoholism and heavy smoking). Conclusion S. saccharolyticus infection is difficult to diagnose due to microbiological characteristics of this bacterium; it requires timely treatment, and improved infection control procedure should be encouraged for high-risk patients.
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Affiliation(s)
| | - Brigitte Lamy
- Laboratoire de Bactériologie, Hôpital L'archet 2, CHU de Nice, Nice, France.,INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Equipe 6, Nice, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Raymond Ruimy
- Laboratoire de Bactériologie, Hôpital L'archet 2, CHU de Nice, Nice, France.,INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Equipe 6, Nice, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Nicolas Amoretti
- Département de Radiologie, Université Cote d'Azur, CHU de Nice, Nice, France
| | - Karine Risso
- Service d'infectiologie, Université Nice Côte d'Azur, CHU de Nice, Nice, France
| | - Christian Roux
- Département de Rhumatologie, Université Cote d'Azur, LAHMESS EA6309, CNRS, iBV UMR 7277, CHU de Nice, Nice, France
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Chau Y, Roux C, Breuil V, Trojani C, Gonzalez JF, Amoretti N, Sédat J. Endovascular Occlusion of Neovascularization as a Treatment for Persistent Pain After Total Knee Arthroplasty. Cardiovasc Intervent Radiol 2020; 43:787-790. [PMID: 32144433 DOI: 10.1007/s00270-020-02449-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA.Level of Evidence IV, Case report.
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Affiliation(s)
- Yves Chau
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France.
| | - Christian Roux
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Véronique Breuil
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Christophe Trojani
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Nicolas Amoretti
- Department of Osteointerventional Radiology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jacques Sédat
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France
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Dekimpe C, Andreani O, De Dompsure RB, Lemmex DB, Layet V, Foti P, Amoretti N. CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome. Eur Radiol 2019; 30:961-970. [PMID: 31628504 DOI: 10.1007/s00330-019-06439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. MATERIALS AND METHODS Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. RESULTS Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. CONCLUSION This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. KEY POINTS • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.
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Affiliation(s)
- Chloé Dekimpe
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France.
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Groupe Arnaud Tzank, Saint Laurent du Var, France
| | - Regis Bernard De Dompsure
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Devin Byron Lemmex
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Vivien Layet
- University Institute of Locomotion and Sports, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Pauline Foti
- Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France
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Lassau N, Estienne T, de Vomecourt P, Azoulay M, Cagnol J, Garcia G, Majer M, Jehanno E, Renard-Penna R, Balleyguier C, Bidault F, Caramella C, Jacques T, Dubrulle F, Behr J, Poussange N, Bocquet J, Montagne S, Cornelis F, Faruch M, Bresson B, Brunelle S, Jalaguier-Coudray A, Amoretti N, Blum A, Paisant A, Herreros V, Rouviere O, Si-Mohamed S, Di Marco L, Hauger O, Garetier M, Pigneur F, Bergère A, Cyteval C, Fournier L, Malhaire C, Drape JL, Poncelet E, Bordonne C, Cauliez H, Budzik JF, Boisserie M, Willaume T, Molière S, Peyron Faure N, Caius Giurca S, Juhan V, Caramella T, Perrey A, Desmots F, Faivre-Pierre M, Abitbol M, Lotte R, Istrati D, Guenoun D, Luciani A, Zins M, Meder JF, Cotten A. Five simultaneous artificial intelligence data challenges on ultrasound, CT, and MRI. Diagn Interv Imaging 2019; 100:199-209. [DOI: 10.1016/j.diii.2019.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 12/18/2022]
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14
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Amoretti N, Kastler A. Trans-isthmic pars interarticularis screwing under double CT and fluorcopic guidance : procedure accuracy and one year follow-up in patients with symptomatic low-grade lumbar isthmic lysis. J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Amoretti N, Baqué J, Litrico S, Stacoffe N, Palmer W. Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided Interlaminar Epidural Steroid Injection. Cardiovasc Intervent Radiol 2019; 42:775-778. [PMID: 30603972 DOI: 10.1007/s00270-018-2151-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
We describe the case of a 30-year-old patient who was referred for lumbar epidural corticosteroid injection due to right L5 radiculopathy. Two months earlier, MRI demonstrated a right large paracentral L4-L5 disk extrusion causing disabling L5 radiculopathy. The L4-L5 level was selected for interlaminar injection, using fluoroscopic guidance. During injection, the patient developed severe pain in both lower extremities. Thus, the procedure was immediately terminated. Paraplegia occurred within several minutes. Urgent lumbar spine CT and MRI demonstrated contrast material in a massive extruded disk fragment and substantial increase in size of the disk extrusion compared to pre-injection MRI. Emergency surgery was performed for lumbar decompression and discectomy. Although rare, serious neurological complication can result from inadvertent intradiscal injection of contrast material during lumbar epidural injection. This case illustrates the importance of recognizing the possibility of dynamic change in the size of an extruded disk fragment when the MRI precedes injection by a substantial time interval. LEVEL OF EVIDENCE: IV, Case Series.
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Affiliation(s)
- Nicolas Amoretti
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France.
| | - Jean Baqué
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Stéphane Litrico
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Nicolas Stacoffe
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
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16
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Amoretti N, Gallo G, Nicolas S, Federico T, Theumann N, Guinebert S, Thouvenin Y, Cornelis F, Hauger O. Contained Herniated Lumbar Disc: CT- and Fluoroscopy-Guided Automated Percutaneous Discectomy-A Revival. Semin Intervent Radiol 2018; 35:255-260. [PMID: 30402008 DOI: 10.1055/s-0038-1673361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The combination of a new device and dual guidance (computed tomography [CT] and fluoroscopy) is similar to other percutaneous devices in achieving a mechanical decompression of the disc. The difference, however, is that the target of the decompression with the current technique is the herniated disc itself. The goal of this combined technique is to create a space, an "olive" around the probe, allowing a decrease in pressure inside the hernia. Percutaneous discectomy under combined CT and fluoroscopic guidance is a minimally invasive spine surgery that should be considered as an alternative to surgery in properly selected patients.
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Affiliation(s)
| | - Giacomo Gallo
- Nice University Hospital, Pasteur Hospital, Nice, France
| | | | - Torre Federico
- Nice University Hospital, Pasteur Hospital, Nice, France
| | | | - Sylvain Guinebert
- Nice University Hospital, Pasteur Hospital, Nice, France.,Bois-Cerf Radiology Institute, Lausanne, Switzerland.,Department of Medical Imaging, Lapeyronie Hospital, University of Montpellier, France.,Interventional Radiology/Interventional Oncology Department, Tenon Hospital, APHP Paris, France.,Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Bordeaux, France.,CME credit is not offered for this article
| | - Yann Thouvenin
- Department of Medical Imaging, Lapeyronie Hospital, University of Montpellier, France
| | - François Cornelis
- Interventional Radiology/Interventional Oncology Department, Tenon Hospital, APHP Paris, France
| | - Olivier Hauger
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Bordeaux, France
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17
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Affiliation(s)
- Nicolas Amoretti
- From the Department of Radiology, Centre Hospitalier Universitaire de Nice, Nice 06003, France
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18
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Amoretti N, Diego P, Amélie P, Andreani O, Foti P, Schmid-Antomarchi H, Scimeca JC, Boileau P. Percutaneous vertebroplasty in tumoral spinal fractures with posterior vertebral wall involvement: Feasibility and safety. Eur J Radiol 2018; 104:38-42. [PMID: 29857864 DOI: 10.1016/j.ejrad.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/07/2018] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE to evaluate the technical feasibility and safety of CT and fluoroscopy guided percutaneous vertebroplasty in the treatment of tumoral vertebral fractures with posterior wall involvement. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. Sixty-three consecutive adult patients (35 women, 28 men; mean age+/- standard deviation: 69 years+/- 14) with tumoral spinal fractures that compromised the posterior wall were treated by means of percutaneous vertebroplasty with CT and fluoroscopy guidance. Only local anesthesia was used during these procedures. Postoperative outcome was assessed using the Kostuik index. RESULTS Sixty-three vertebroplasties were performed on thirty-four thoracic (54%), twenty-six lumbar (41%), and three (5%) cervical vertebrae. The etiologies of the fractures were metastasis in twenty-eight (44%), myeloma in twenty-five (40%) and hemangioma in ten (16%). Almost all fractures (94%) were consolidated after vertebroplasty (score of Kostuik <3) (p < 0.001). No major complications were reported in our series of cases. CONCLUSION This study suggests that tumoral spinal fractures with posterior vertebral wall involvement can be successfully and safely treated by CT- and fluoroscopy-guided percutaneous vertebroplasty.
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Affiliation(s)
- Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France.
| | - Palominos Diego
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Pellegrin Amélie
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Pauline Foti
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Heidy Schmid-Antomarchi
- Institut de Biologie Valrose, Université cote d'azur, Tour Pasteur, UFR Médecine, 28 Ave de Valombrose, 06107 Nice Cedex 2, France
| | - Jean-Claude Scimeca
- Institut de Biologie Valrose, Université cote d'azur, Tour Pasteur, UFR Médecine, 28 Ave de Valombrose, 06107 Nice Cedex 2, France
| | - Pascal Boileau
- Orthopaedic Surgery Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
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19
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Cornelis FH, Petitpierre F, Fabre T, Gille O, Amoretti N, Hauger O. Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions. Eur Radiol 2017; 27:3942-3946. [PMID: 28124748 DOI: 10.1007/s00330-016-4703-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/21/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate low-pressure bone stenting combined with cementoplasty in extensive lytic lesions. METHODS A single-centre study involving four consecutive patients (four women) with extensive lytic tumours was performed. The average age was 65 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under fluoroscopy guidance. Follow-up was assessed using the visual analogue scale (VAS). RESULTS Under general (n = 2) or local (n = 2) anaesthesia, five 11-gauge bone biopsy needles were advanced in four lesions. Five auto-expandable uncovered stents (10-14 mm diameter and 40-60 mm long) were inserted. In all cases, bone cement was successfully placed into the tumours. The volume of cement that was injected through the cannulas into the stents was 5-10 mL. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 after the procedure for all patients (p < 0.05). No complications occurred during the follow-up (8-19 months). CONCLUSION This study suggests that cementoplasty combined with low-pressure bone stenting could allow effective bone stabilization resulting in pain relief. KEY POINTS • Low-pressure bone stenting is possible. • This technique improves cement injection control. • The procedure allows effective bone stabilization resulting in pain relief.
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Affiliation(s)
- Francois H Cornelis
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France.
- Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | - Francois Petitpierre
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Thierry Fabre
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Nicolas Amoretti
- Department of Radiology, Hôpital Archet 2, CHU Nice, 151 route Saint Antoine de Ginestiere, 06202, Nice, France
| | - Olivier Hauger
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
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20
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Maratos YK, Gombergh R, Cornier E, Minart JP, Amoretti N, Mpotsaris A. The G-spot: an observational MRI pilot study. BJOG 2016; 123:1542-9. [DOI: 10.1111/1471-0528.13864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- YK Maratos
- Centre d'Imagerie Médicale Numérisée (CIMN); Paris France
| | - R Gombergh
- Centre d'Imagerie Médicale Numérisée (CIMN); Paris France
| | | | | | - N Amoretti
- Department of Radiology; Centre Hospitalo-Universitaire de Nice; Nice France
| | - A Mpotsaris
- Department of Radiology and Neuroradiology; University Hospital of Cologne; Cologne Germany
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Gallo G, Caudal A, Bronsard N, Hauger O, Amoretti N. Stabilisation of a loosened femoral gamma nail by percutaneous cement injection (cementoplasty): a new technique. Skeletal Radiol 2015; 44:1535-9. [PMID: 26138339 DOI: 10.1007/s00256-015-2193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
Abstract
Surgical repair of pertrochanteric and subtrochanteric fractures in the elderly is usually achieved using an endomedullary nail. Unfortunately, even today, some of the patients who undergo this intervention develop periprosthetic bone absorption over time that can lead to loosening of the prosthesis, resulting in pain, joint instability and the need for revision surgery. Surgical revision is hindered by potential complications related to patients' existing underlying medical conditions. It is often the case that these patients are weak and present comorbidities, which can lead to an absolute contraindication to surgery. An interesting alternative could be the stabilisation by percutaneous injection of cement (cementoplasty) in the periprosthetic space under CT and fluoroscopic guidance. In patients with absolute contraindication we performed percutaneous cementoplasty as treatment for femoral prosthesis loosening. Our procedure was technically a success following the end of the intervention period (follow-up: 6 months). The patient no longer experienced significant pain and showed stability of the prosthesis, as demonstrated by CT.
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Affiliation(s)
- Giacomo Gallo
- Service of Radiology, Centre Hospitalier Universitaire Archet 2, 151 route de Saint-Antoine-de-Ginestière, Nice, France
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Bronsard N, Chignon Sicard B, Amoretti N, Rottier H, Ertz P, de Peretti F. Interest of including trauma photography in the picture archiving and communication system of a teaching hospital. Orthop Traumatol Surg Res 2015; 101:387-90. [PMID: 25817905 DOI: 10.1016/j.otsr.2015.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/02/2015] [Accepted: 02/06/2015] [Indexed: 02/02/2023]
Abstract
Digital imaging is a daily practice in traumatology. Such photographs should remain confidential. However, there is a need for objectivity concerning the circumstances and clinical follow-up for trauma patients. This paper describes how to conserve these photographs within the picture archiving and communication system (PACS) safely as regards identity and confidentiality. A computer converts the photographs into DICOM files. The DICOM image is associated to a reconciliation layer, validated by the physician in charge, and then included in the hospital PACS. This improves transmission from one medical team to another, both initially and after the accident if an expert medical opinion is required. The literature has demonstrated the value of photographs in modern medicine, but the technical and legal challenges are many. They enhance the computerized medical records. Identification, confidentiality and integration in the PACS are obstacles that we have now overcome.
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Affiliation(s)
- N Bronsard
- Service de chirurgie orthopédique et traumatologie, hôpital St.-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
| | - B Chignon Sicard
- Service de chirurgie réparatrice, hôpital St.-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - N Amoretti
- Service d'imagerie médicale, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - H Rottier
- Direction des services informatiques, hôpital Archet 1, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - P Ertz
- Service de chirurgie orthopédique et traumatologie, hôpital St.-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - F de Peretti
- Service de chirurgie orthopédique et traumatologie, hôpital St.-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
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Amoretti N, Bertrand AS, Gallo G, Caudal A, Cornelis F, Hauger O, Boileau P. Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique. Eur Radiol 2014; 25:1135-9. [PMID: 25358596 DOI: 10.1007/s00330-014-3475-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists. METHODS A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS). RESULTS In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p < 0.05). CONCLUSION This study suggests that loosening of spine arthrodesis could be successfully treated by percutaneous injection of bone cement under CT and fluoroscopy guidance. KEY POINTS • PLIF is one of the surgical techniques for spinal arthrodesis. • Treatment indications are degenerative disease or instability following trauma, tumour, or infection. • Screw loosening is a frequent complication that can occur after surgery. • Percutaneous facet consolidation under dual guidance seems to be a feasible technique. • The procedure is performed under local anaesthesia using a minimally invasive approach.
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Amoretti N, Huwart L. Combination of percutaneous osteosynthesis and vertebroplasty of thoracolumbar split fractures under CT and fluoroscopy guidance: a new technique. Cardiovasc Intervent Radiol 2014; 37:1363-8. [PMID: 24482031 DOI: 10.1007/s00270-014-0849-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of our study was to evaluate the technical feasibility of the combination involving percutaneous screw fixation and vertebroplasty in split fractures of thoracolumbar spine. METHODS Institutional review board approval and informed consent were obtained. Ten consecutive adult patients who had posttraumatic vertebral split fractures (Magerl A2) were prospectively treated by an interventional radiologist under computed tomography and fluoroscopy guidance. Using a bilateral route under local anesthesia, one 4.0-mm cannulated screw was placed on one side to fix the fracture, and on the other side, vertebroplasty was performed. Follow-up ranging from 12 to 24 months was assessed using visual analog scale (VAS) and Oswestry disability index (ODI) RESULTS: Combined procedures were performed on thoracic and lumbar vertebrae, creating both osteosynthesis and cement bridge between the displaced fragment and the rest of the vertebral body. Mean VAS measurements ± standard deviation (SD) decreased from 7.5 ± 1.5 preoperatively to 3.2 ± 1.9 at 1 day, 2.1 ± 1.2 at 1 month, and 1.9 ± 1.4 at the last examination (P < 0.001). Mean ODI scores ± SD decreased from 65.3 ± 16.2, preoperatively, to 16.1 ± 5.0 at the final examination (P < 0.001). CONCLUSIONS This study suggests that type A2 vertebral fractures could be successfully stabilized by the combination of percutaneous osteosynthesis and vertebroplasty.
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Affiliation(s)
- Nicolas Amoretti
- Department of Radiology, Centre Hospitalo-Universitaire de Nice, Hôpital Archet 2, 151, route Saint-Antoine de Ginestière, 06200, Nice, France
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Cornelis F, Truchetet ME, Amoretti N, Verdier D, Fournier C, Pillet O, Gille O, Hauger O. Bisphosphonate therapy for unresectable symptomatic benign bone tumors: a long-term prospective study of tolerance and efficacy. Bone 2014; 58:11-6. [PMID: 24120668 DOI: 10.1016/j.bone.2013.10.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the long-term tolerance of bisphosphonates proposed as an alternative therapeutic option for symptomatic unresectable benign bone tumors and to evaluate the long-term efficacy of this treatment. METHODS From March 2007 to March 2011, patients with unresectable symptomatic benign bone tumors were consecutively included in this institutional review board-approved study and treated with bisphosphonates. Prospectively long-term follow-up is reported. The study endpoints were to describe the long-term tolerance, the clinical evolution of pain for each patient and the radiological success defined as a complete disappearance of inflammation and ossification of the bone lesion. All complications and side effects were recorded. RESULTS Eight patients (mean age 16 years; range 7-42) with various tumor subtypes were included: aneurysmal bone cysts (N=5), Langerhans cell histiocytosis (N=1), osteoblastoma (N=1), and a giant cell tumor (N=1). Tumors were located in cervical (N=4) or thoracic (N=1) vertebrae, femoral shaft (N=1), acetabulum (N=1) and sacrum (N=1). Mean number of bisphosphonate cycles was 3 (range: 1-6) over a median period of 10 months. The median clinical and imaging follow-up period was 21 months (6 to 63 months). No severe complications due to treatment or lesion recurrence were reported. Pain disappeared within 6 weeks of the first cycle for all but one patient. Ossification of the bone lesion was observed for all patients but one, complete for two and partial for the five others. CONCLUSIONS Bisphosphonates appear to be an effective option without adverse effects for the non-operative management of symptomatic benign bone tumors.
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Affiliation(s)
- F Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
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Bronsard N, Boli T, Challali M, de Dompsure R, Amoretti N, Padovani B, Bruneton G, Fuchs A, de Peretti F. Comparison between percutaneous and traditional fixation of lumbar spine fracture: intraoperative radiation exposure levels and outcomes. Orthop Traumatol Surg Res 2013; 99:162-8. [PMID: 23453915 DOI: 10.1016/j.otsr.2012.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 09/25/2012] [Accepted: 12/17/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare radiation exposure doses and clinical and radiological outcomes between percutaneous pedicular screwing (closed reduction internal fixation [CRIF]) and classical open reduction internal fixation (ORIF) in lumbar spine fracture without neurologic deficit. MATERIALS AND METHODS Sixty patients (mean age, 42.5 years) were divided into two treatment groups: (Percutaneous) CRIF versus (traditional) ORIF. Screw position and anatomic vertebral reconstruction were checked on routine control X-ray and postoperative CT scan. Study parameters comprised: surgery time, radiation exposure time, radiation dose level for X-ray (DAP) and for CT (DLP),blood loss, length of hospital stay and postoperative pain (VAS). RESULTS At a mean 25.5 months' follow-up,there were no significant inter-group differences on the epidemiological parameters: age, gender, fracture level, fracture type on the Magerl classification, preoperative local vertebral kyphosis angle, or fracture-to-surgery interval. Effective radiation dose was 3-fold higher in CRIF than in ORIF, but 6-fold lower than for the postoperative CT scan. Postoperative pain on VAS was significantly lower after CRIF, allowing earlier gait resumption and return to work and daily activity. There were no significant differences in length of hospital stay, patient satisfaction, screw malpositioning or postoperative or end-of-follow-up kyphosis angle. CONCLUSION Percutaneous surgery provided clinical and radiological outcomes strictly comparable to those of open surgery, but with a higher effective radiation exposure dose, including for the medical team and especially for the surgeon. This higher exposure dose, however, is to be relativized by comparison to that of the postoperative CT scan, which involved a much higher exposure dose for the patient. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- N Bronsard
- Nice University Hospital Center, Orthopedic and Traumatologic Surgery Department, Hôpital Saint Roch, 5, rue Pierre-Dévoluy, 06000 Nice, France.
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Amoretti N, Amoretti ME, Hovorka I, Hauger O, Boileau P, Huwart L. Percutaneous facet screw fixation of lumbar spine with CT and fluoroscopic guidance: a feasibility study. Radiology 2013; 268:548-55. [PMID: 23481163 DOI: 10.1148/radiol.13120907] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria. RESULTS The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination. CONCLUSION This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.
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Affiliation(s)
- Nicolas Amoretti
- Departments of Radiology, Hôpital Archet 2, Teaching Hospital of Nice, 151 route Saint-Antoine de Ginestière, 06200 Nice, France
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Cornelis F, Havez M, Lippa N, Al-Ammari S, Verdier D, Carteret T, Amoretti N, Gangi A, Palussiere J, Hauger O, Grenier N. Radiologically guided percutaneous cryotherapy for soft tissue tumours: A promising treatment. Diagn Interv Imaging 2013; 94:364-70. [PMID: 23491212 DOI: 10.1016/j.diii.2013.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies of percutaneous cryotherapy in the treatment of benign or malignant soft tissue tumours are rare and mainly involve small populations. Nevertheless, results show cryotherapy's potential in terms of local control of tumours, analgesic efficacy, reduced intra- and postoperative complications, and reduction in the length of convalescence after the procedure. The objective of this update is to set out the short-term prospects for this technique in the treatment of soft tissue tumours, so that it may be more widely offered in these indications.
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Affiliation(s)
- F Cornelis
- Adult Diagnostic and Interventional Imaging Department, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France.
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Affiliation(s)
- P Y Marcy
- Medical imaging Department, François Baclesse Center, 3, avenue du Général-Harris, 14076 Caen cedex 05, France.
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Amoretti N, Coco L, Nouri Y, Marcy PY, Ianessi A, Amoretti ME, Hauger O. Inhalation study of polymethyl methacrylate following radiologist exposure during percutaneous vertebroplasty. Skeletal Radiol 2013; 42:203-7. [PMID: 22438125 DOI: 10.1007/s00256-012-1370-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 10/24/2011] [Accepted: 01/11/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the atmospheric concentrations of methyl methacrylate (MMA) vapors during percutaneous vertebroplasty for the interventional radiologist and the other operating room staff. MATERIALS AND METHODS During percutaneous vertebroplasty, a polymethyl methacrylate (PMMA) mixture (about 20 mL) was prepared with a mixing system in a normally ventilated room. Atmospheric concentrations of MMA vapors were measured by a gas absorbent badge for individual exposure (GABIE) passive sampler attached to the surgical gowns of the interventional radiologist and the other operating room staff over a period of 460 min. Active sampling was performed over 15 min with an individual pump placed near the breathing zone of the radiologist. MMA vapor concentrations were then measured using gas chromatography and activated charcoal tubes. RESULTS Mean MMA vapor concentrations measured by the GABIEs over the period of 460 min were 0.51 parts per million (ppm) for the radiologist and 0.22 ppm for the other operating room staff. The emission peaks measured by using charcoal tubes over 15 min were 3.7 ppm. CONCLUSION MMA vapor concentrations during percutaneous vertebroplasty were well below the recommended maximum exposure of 100 ppm over the course of an 8-h workday.
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Affiliation(s)
- Nicolas Amoretti
- Service d'Imagerie Médicale, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet 2, 151 route de Saint Antoine de Ginestière, B.P 3079, 06202, Nice Cedex 3, France.
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Amoretti N, Huwart L, Marcy PY, Foti P, Hauger O, Boileau P. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs. Skeletal Radiol 2013; 42:49-53. [PMID: 22644540 DOI: 10.1007/s00256-012-1422-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 01/09/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). MATERIALS AND METHODS A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. RESULTS In group 1, the patients had a mean pain score of 7.9 ± 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 ± 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 ± 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 ± 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 ± 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 ± 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 ± 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 ± 0.5 VAS units (range 0-10 units) at 6 months. CONCLUSION Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially.
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Affiliation(s)
- Nicolas Amoretti
- Department of Radiology, Hôpital archet 2, Centre Hospital-Universitaire de Nice, 151, route de saint antoine de Ginestière, 06200, Nice, France.
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Amoretti N, Huwart L. Percutaneous screw fixation of a talar fracture under computed tomography and fluoroscopy guidance. J Vasc Interv Radiol 2012. [PMID: 23177119 DOI: 10.1016/j.jvir.2012.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Iannessi A, Amoretti N, Marcy PY, Sedat J. Percutaneous cementoplasty for the treatment of extraspinal painful bone lesion, a prospective study. Diagn Interv Imaging 2012; 93:859-70. [DOI: 10.1016/j.diii.2012.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Brunner P, Amoretti N, Soares F, Brunner E, Cazaux E, Brocq O, Chanalet S, Liberatore M, Cucchi JM, Mourou MY, Michelozzi G, Robino C. Approaches in injections for radicular pain: the transforaminal, epidural and transfacet approaches. Diagn Interv Imaging 2012; 93:711-22. [PMID: 22925594 DOI: 10.1016/j.diii.2012.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Spinal injections must be carried out adhering to very strict conditions. However, these procedures have almost come to be seen as everyday and may be practised under quite questionable conditions. The recent reports of new and extremely serious neurological complications have changed the attitudes of those making referrals as well as the attitudes of the interventional radiologists carrying out these procedures. The range of indications for transforaminal injections has shrunk in favour of epidural injections. Where the transforaminal approach is still used, the needle must be positioned extremely accurately. A prior radioopaque contrast medium injection is essential from a safety perspective. The transforaminal epidural injection via the transfacet approach looks to be a promising alternative that is strictly avascular.
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Affiliation(s)
- P Brunner
- Princesse Grace Hospital, Monaco Cedex, Principality of Monaco.
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35
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Amoretti N, Huwart L, Hauger O, Browaeys P, Marcy PY, Nouri Y, Ibba C, Boileau P. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique. Eur Radiol 2012; 22:2841-7. [DOI: 10.1007/s00330-012-2536-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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Amoretti N, Huwart L, Foti P, Boileau P, Amoretti ME, Pellegrin A, Marcy PY, Hauger O. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections. Eur Radiol 2012; 22:2836-40. [DOI: 10.1007/s00330-012-2533-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 11/30/2022]
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Marcy PY, Lacout A, Amoretti N, Figl A, Thariat J, Simon JJ. Criteria to choose between distal or proximal venous port device insertion in HNC patients. Cardiovasc Intervent Radiol 2012; 36:874-5. [PMID: 22678237 DOI: 10.1007/s00270-012-0402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 04/17/2012] [Indexed: 11/25/2022]
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Amoretti N, Huwart L. Percutaneous extraction of cement leakage after vertebroplasty under CT and fluoroscopy guidance: a new technique. Cardiovasc Intervent Radiol 2012; 35:1492-5. [PMID: 22610299 DOI: 10.1007/s00270-012-0414-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/06/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE We report a new minimally invasive technique of extraction of cement leakage following percutaneous vertebroplasty in adults. METHODS Seven adult patients (five women, two men; mean age: 81 years) treated for vertebral compression fractures by percutaneous vertebroplasty had cement leakage into perivertebral soft tissues along the needle route. Immediately after vertebroplasty, the procedure of extraction was performed under computed tomography (CT) and fluoroscopy guidance: a Chiba needle was first inserted using the same route as the vertebroplasty until contact was obtained with the cement fragment. This needle was then used as a guide for an 11-gauge Trocar t'am (Thiebaud, France). After needle withdrawal, a 13-gauge endoscopy clamp was inserted through the cannula to extract the cement fragments. The whole procedure was performed under local anesthesia. RESULTS In each patient, all cement fragments were withdrawn within 10 min, without complication. CONCLUSIONS This report suggests that this CT- and fluoroscopy-guided percutaneous technique of extraction could reduce the rate of cement leakage-related complications.
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Affiliation(s)
- Nicolas Amoretti
- Department of Radiology, Centre Hospitalo-Universitaire de Nice, Hôpital Archet 2, 151, Route Saint-Antoine de Ginestière, 06200, Nice, France.
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Amoretti N, Marcy PY, Hauger O, Browaeys P, Amoretti ME, Hoxorka I, Boileau P. Percutaneous screw fixation of a vertebral pedicle fracture under CT-guidance: A new technique. Eur J Radiol 2012; 81:591-3. [DOI: 10.1016/j.ejrad.2011.01.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 12/29/2010] [Accepted: 01/03/2011] [Indexed: 11/29/2022]
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Amoretti N, Hauger O, Poussange N, Browaeys P, Huwart L, Marcy PY, Amoretti ME, Hovorka I, Coco L, Benzaken T, Nouri Y, Bronsard N, Ibba C, Boileau P. Discoscanner : indications, technique, trucs et astuces, interprétation. J Neuroradiol 2012; 39:44-50. [DOI: 10.1016/j.neurad.2011.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 05/09/2011] [Accepted: 05/28/2011] [Indexed: 11/16/2022]
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Amoretti N, Iannessi A, Lesbats V, Marcy PY, Hovorka E, Bronsard N, Fonquerne ME, Hauger O. Imaging of intervertebral disc prostheses. Diagn Interv Imaging 2012; 93:10-21. [PMID: 22277706 DOI: 10.1016/j.diii.2011.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disc arthroplasty is the replacement of a painful pathological intervertebral disc by a prosthesis, which, unlike spinal fixation, has the advantage of retaining vertebral mobility in the segment concerned. The success of the procedure is dictated by the indication. The radiologist must look for radiographic arguments indicating or contraindicating fitting an implant, and particularly for the presence of facet arthritis which will prompt the surgeon to choose an arthrodesis. Moreover, radiological information plays a major part in preparing for a surgical procedure, as far as access to the disc via the anterior approach is concerned and assessment by CT angiography of the risk of vascular complications. After insertion, radiological monitoring using dynamic X-ray images checks that the implant is correctly positioned and that mobility is restored. In the long term, it can detect complications related to the prosthesis and premature wear to other points of support such as adjacent discs and the facet joints.
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Affiliation(s)
- N Amoretti
- Service d'imagerie médicale, hôpital l'Archet 2, CHU de Nice, route Saint-Antoine-Ginestière, Nice, France
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Hauger O, Pelé E, Poussange N, Fournier C, Amoretti N. [Labral pathology and impingement]. ACTA ACUST UNITED AC 2011; 92:524-34. [PMID: 21704248 DOI: 10.1016/j.jradio.2011.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
The acetabular labrum, a fibrocartilaginous structure essential to the proper functioning of the hip joint, may be damaged from a variety of conditions including femoroacetabular impingement. FAI is defined by abnormal contact between the femur and acetabulum and is characterized by an underlying morphological abnormality of the femur (dysplastic bump at the head/neck junction, Cam effect), acetabulum (excessive coverage, Pincer effect), or both. The abnormal morphology is suspected on plain films and additional evaluation with either CT or MR arthrography is then performed. The role of the radiologist is to describe the imaging findings while allowing the clinician to make the diagnosis based on clinical symptoms (groin pain, reduced internal rotation). Comprehensive evaluation of the underlying structural abnormalities and associated lesions is important to optimize surgical management with the goal of reducing painful symptoms, improve range of motion and prevent early hip joint degeneration.
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Affiliation(s)
- O Hauger
- Service d'Imagerie Diagnostique et Thérapeutique de L'adulte, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
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Amoretti N, Amoretti ME, Hauger O, Marcy PY, Browaeys P, Hovorka I, Benarrous A, Benzaken T, Coco L, Brunner P, Boileau P. [Posterior percutaneous arthrodesis under CT guidance after surgical anterior arthrodesis: a new technique]. J Neuroradiol 2011; 38:178-82. [PMID: 21496925 DOI: 10.1016/j.neurad.2011.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 11/29/2022]
Abstract
Transfacet screws may be useful for stabilizing segments reconstructed with bone graft or cages, the role of supplementary posterior fixation, particularly minimally invasive techniques such as transfacetar percutaneous screws is relevant. To benefit from a mechanical fixation after anterior arthrodesis without the inconveniences of the open classical posterior surgical intervention, we have developed a new procedure performed under local anesthesia and CT guidance and based on the intra-articular application of screws. This study was designed to demonstrate the feasibility of using a CT-scan to perform posterior arthrodesis of the spine under local anesthesia.
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Affiliation(s)
- N Amoretti
- Département de radiologie, centre hospitalier universitaire de Nice, 06200 Nice, France.
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Amoretti N, Hauger O, Marcy PY, Amoretti ME, Lesbats V, Yvonne M, Ianessi A, Boileau P. Percutaneous discectomy on lumbar radiculopathy related to disk herniation: why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol 2011; 81:1259-64. [PMID: 21444169 DOI: 10.1016/j.ejrad.2011.02.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
The primary objective of this study conducted on 100 patients is to demonstrate that performing CT-guided percutaneous discectomy for herniated disks results in a significant improvement in pain symptoms at several times (D1, D2, D7, 1 month, 3 months, 6 months). This objective assesses the effectiveness and feasibility of this technique under CT guidance in patients presenting documented lower back pain related to disk herniation that has not improved with appropriate medical treatment. The impact of various factors on the effectiveness of discectomy will also be evaluated. At 1 week, we notes a decrease in average VAS respectively of 71% and 67% in patients treated for posterolateral and foraminal herniated disks; the result for posteromedian herniated disks is only 45% in average decrease. At 6 months post op, 79% of lateralized herniated disks have a satisfactory result (≥ 70% decrease in pain as compared to initial pain), whereas post median herniated disks had a satisfactory result in only 50% of cases. Percutaneous fine needle discectomy probe under combined CT and fluoroscopic guidance is a minimally invasive spine surgery which should be considered as an alternative to surgery. This technique presents several advantages: the small diameter of the probe used (maximum 16 G or 1.5mm) allows a cutaneous incision of only a few millimeters, and a trans-canal approach can be possible; it also decreases the risk of ligamentary lesion and does not cause an osseous lesion of the posterior arc or of the adjacent muscular structures.
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Affiliation(s)
- Nicolas Amoretti
- Radiology Department, Centre Hospitalier Universitaire, 06200 Nice, France.
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Roux CH, Breuil V, Valerio L, Amoretti N, Brocq O, Albert C, Grisot C, Allam Y, Chevalier P, Pradier C, Euller-Ziegler L. Etanercept compared to intraarticular corticosteroid injection in rheumatoid arthritis: double-blind, randomized pilot study. J Rheumatol 2011; 38:1009-11. [PMID: 21406499 DOI: 10.3899/jrheum.100828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare etanercept (anti-tumor necrosis factor-α) with intraarticular (IA) corticosteroid injections to treat rheumatoid arthritis (RA). METHODS Patients with RA who had persistent monoarthritis received etanercept or IA corticosteroid injections. Efficacy was compared at Weeks 4 and 24. RESULTS Thirty-four patients were included (8 dropped out). Mean age was 58.8 years. No difference between groups was found at Weeks 4 or 24, but both groups showed significant improvement at Weeks 4 and 24 compared to baseline. CONCLUSION Etanercept and IA steroid injections resulted in significant improvement at Week 4 that persisted to Week 24. There was no significant difference in outcome between the groups.
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Affiliation(s)
- Christian H Roux
- Rheumatology Department, Hospital l'Archet 1, 242 Route de Saint Antoine de Ginestiere, 06200 Nice, France.
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Amoretti N, Lesbats-Jacquot V, Marcy PY, Hauger O, Maratos Y, Ianessi A, Amoretti ME. [Vertebroplasty and kyphoplasty under dual guidance (CT and fluoroscopy): radiation dose to radiologist. A comparative study]. J Neuroradiol 2011; 38:135-40. [PMID: 21227508 DOI: 10.1016/j.neurad.2010.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 09/26/2010] [Accepted: 10/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goals of this study is to evaluate and compare the irradiation received by the practitioner when performing percutaneous vertebroplasty or kyphoplasty guided by CT and fluoroscopy, for precise anatomical sites. METHODS For each intervention, radiothermoluminescent dosimeters were carefully positioned on both orbitals, both hands, and both ankles of the practitioner. RESULTS Twenty-four vertebroplasties were performed in 18 patients and nine kyphoplasties on seven patients. The anatomical site that is most exposed to radiation is the right hand. The two other sites subjected to irradiation are the left hand and the left orbital. This study demonstrates a significant correlation between the irradiation dose and fluoroscopy duration, reflecting both the quantity of primary-beam radiation and backscattered radiation. CONCLUSION The radiation dose to radiologist is more important for kyphoplasty procedures than vertebroplasty.
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Affiliation(s)
- N Amoretti
- Radiology department, CHU de Nice, 06200 Nice, France.
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Amoretti N, Lesbats V, Marcy PY, Hauger O, Amoretti ME, Maratos Y, Ianessi A, Boileau P. Dual guidance (CT and fluoroscopy) vertebroplasty: radiation dose to radiologists. How much and where? Skeletal Radiol 2010; 39:1229-35. [PMID: 20496066 DOI: 10.1007/s00256-010-0931-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 02/21/2010] [Accepted: 04/05/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate the radiation received by the practitioner when performing percutaneous vertebroplasty guided by CT and fluoroscopy for specific anatomical sites: orbits, hands, ankles, and thorax (under lead-lined apron). MATERIALS AND METHODS Twenty-four vertebroplasties were performed on 18 patients. RESULTS The anatomical site that was most exposed to radiation was the right hand (0.37 mSv on average). This study demonstrates a significant correlation between the irradiation dose and fluoroscopy duration, reflecting both the quantity of primary-beam radiation and backscattered radiation. The right hand (P = 0.03), left hand (P = 0.02), and the left orbit (P < 0.0001) are the anatomical zones that are the most affected by the combination of these two types of radiation, with cumulative irradiation doses of 0.45, 0.2, and 0.14 mSv, respectively. There was a significant correlation between the patient weight and radiation of the left hand (P = 0.03), the left orbit (P = 0.03), and the thorax (P = 0.02), confirming the major influence of backscattered radiation. CONCLUSIONS The most irradiated anatomical sites limiting the number of interventions are the left orbit and the right hand.
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Affiliation(s)
- Nicolas Amoretti
- Radiology Department, Centre hospitalier universitaire, Nice, France.
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Marcy PY, Figl A, Amoretti N, Ianessi A. Arm port implantation in cancer patients. Int J Clin Oncol 2010; 15:328-30. [PMID: 20195679 DOI: 10.1007/s10147-010-0041-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 11/08/2009] [Indexed: 11/24/2022]
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Amoretti N, Hauger O, Marcy PY, Hovorka I, Lesbats-Jacquot V, Fonquerne ME, Maratos Y, Boileau P. Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique. Eur Radiol 2009; 20:190-2. [DOI: 10.1007/s00330-009-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 05/10/2009] [Accepted: 05/22/2009] [Indexed: 11/24/2022]
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