- Number Needed to Treat with Vertebral Augmentation to Save a Life
The purpose of this study was to calculate the number needed to treat to save 1 life at 1 year and up to 5 years after vertebral augmentation. A 10-year sample of the 100% US Medicare data base was used to identify patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, and vertebroplasty. The number needed to treat was calculated between augmentation and nonsurgical management groups from years 1–5 following a vertebral compression fracture diagnosis, using survival probabilities for each management approach. The adjusted number needed to treat to save 1 life for nonsurgical management versus kyphoplasty ranged from 14.8 at year 1 to 11.9 at year 5. The adjusted number needed to treat for nonsurgical management versus vertebroplasty ranged from 22.8 at year 1 to 23.8 at year 5. The authors conclude that the NNT analysis of more than 2 million patients with VCF reveals that only 15 patients need to be treated to save 1 life at 1 year. This has an obvious clinically significant impact and given that all augmentation clinical trials are underpowered to detect a mortality benefit, this large dataset analysis reveals that vertebral augmentation provides a significant mortality benefit over nonsurgical management with a low NNT.
- Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease
Twenty-nine patients with Moyamoya disease were enrolled in this study. The median age at symptom onset was 12 years. A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 4 lesions in 3 patients showed grade II enhancement. The presence of contrast enhancement and wall thickening showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. The presence of wall thickening and enhancement may predict future ischemic events in patients with MMD.
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