- Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures
This study assesses the results of armed kyphoplasty using vertebral body stents or the SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion. The authors performed a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively, and mean vertebral body height was 10.8 and 16.7 mm, respectively. They conclude that in the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplastyyields fracture reduction, internal fixation, and indirect central canal decompression.
- Evaluation of Lower-Dose Spiral Head CT for Detection of Intracranial Findings Causing Neurologic Deficits
Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. A routine dose was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence, and image quality. The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87. Noninferiority was shown for 100-effective mAs iterative reconstruction and 200-effective mAs filtered back-projection, but not for100-effective mAs filtered back-projection. The authors conclude that substantial opportunity exists for dose reduction using spiral nonenhanced head CT and that the dose level might potentially be reduced to 40% of routine dose levels or a volume CT dose index of approximately 15mGy if slight decreases in performance are acceptable. The beneficial effect of iterative reconstrution was most pronounced at this 15-mGy dose level.
- Comparison of [18F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management
Ten patients with clinically suspected facetogenic low back pain were prospectively recruited with a designation of specific facet joints implicated clinically. Subsequently, patients underwent an FDG-PET/MR imaging examination with gadolinium. Each facet joint was graded for perifacet signal change on MR imaging and FDG activity. The frequency and correlation of MR imaging, FDG-PET, and clinical findings were determined. There was low concordance of perifacet signal change and FDG activity with clinically implicated facet joints. This could indicate either the potential to change patient management or a lack of biomarker accuracy.
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