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Introduction Vertebral augmentation procedures are widely used today in treating Osteoporotic vertebral compression fractures (OVCFs) especially in acute and subacute fractures. However, percutaneous vertebroplasty for patients with chronic painful OVCFs has been less well studied. The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty with conservative management for the treatment of chronic painful OVCFs in the thoracolumbar spine among Egyptian patients. Patients and methods This prospective cohort study included 60 patients with chronic OVCFs (38 females, 22 males, mean age: 65.42 ± 8.63) who presented with severe back pain to the outpatient clinic during the period from October 2005 to December 2011. Twenty-eight patients were treated with percutaneous vertebroplasty (vertebroplasty group). Thirty two patients refused surgical treatment and constituted the control group (Conservative group). The inclusion criteria included: Chronic painful OVCFs (at least 3 months), at least 50 years old, T5 to L5, osteoporosis (T-score -2.5 or lower), Visual Analogue Scale (VAS) at least 5, and absence of neurological deficits. At presentation, all patients of both groups received back brace, analgesics, anti-osteoporosis therapy. All patients were evaluated with X rays and CT scan, where Cobb angle and the anteroposterior height comparison (APHC) were measured. Overall pain and quality of life were assessed with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results All patients were followed for at least 12 months (range, 12 to 28). Statistical analysis of the demographic data of the two groups could not reveal any significant differences. At latest follow up, there was significant improvement in Cobb angle and APHC in vertebroplasty group compared with conservative group (p 0.05). Twenty nine patients (90.63%) showed complete union in the conservative group while all patients (100%) showed complete union in the vertebroplasty group at latest follow up.VAS and ODI were significantly better in vertebroplasty group than conservative group (P0.05) at latest follow up.Cement extravasation into the disc occurred in 2 patients (5.41%), and into the paravertebral tissue in 3 (8.11%); none was associated with neurological symptoms, cement embolism, or infection.Recent fracture occurred adjacent to the formerly cemented ones in 2 patients (7.14%) and in non-adjacent level in one (3.57%). In conservative group, 3 patients (9.37%) presented with new osteoporotic vertebral fractures in adjacent levels and 2 (6.25%) in non adjacent levels. Three patients (9.37%) showed non union. Conclusion Percutaneous vertebroplasty is safe and effective in treatment of symptomatic chronic osteoporotic vertebral compression fractures with significantly better clinical and radiological outcomes when compared with conservative management.

Introduction Vertebral augmentation procedures are widely used today in treating Osteoporotic vertebral compression fractures (OVCFs) especially in acute and subacute fractures. However, percutaneous vertebroplasty for patients with chronic painful OVCFs has been less well studied. The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty with conservative management for the treatment of chronic painful OVCFs in the thoracolumbar spine among Egyptian patients. Patients and methods This prospective cohort study included 60 patients with chronic OVCFs (38 females, 22 males, mean age: 65.42 ± 8.63) who presented with severe back pain to the outpatient clinic during the period from October 2005 to December 2011. Twenty-eight patients were treated with percutaneous vertebroplasty (vertebroplasty group). Thirty two patients refused surgical treatment and constituted the control group (Conservative group). The inclusion criteria included: Chronic painful OVCFs (at least 3 months), at least 50 years old, T5 to L5, osteoporosis (T-score -2.5 or lower), Visual Analogue Scale (VAS) at least 5, and absence of neurological deficits. At presentation, all patients of both groups received back brace, analgesics, anti-osteoporosis therapy. All patients were evaluated with X rays and CT scan, where Cobb angle and the anteroposterior height comparison (APHC) were measured. Overall pain and quality of life were assessed with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results All patients were followed for at least 12 months (range, 12 to 28). Statistical analysis of the demographic data of the two groups could not reveal any significant differences. At latest follow up, there was significant improvement in Cobb angle and APHC in vertebroplasty group compared with conservative group (p 0.05). Twenty nine patients (90.63%) showed complete union in the conservative group while all patients (100%) showed complete union in the vertebroplasty group at latest follow up.VAS and ODI were significantly better in vertebroplasty group than conservative group (P0.05) at latest follow up.Cement extravasation into the disc occurred in 2 patients (5.41%), and into the paravertebral tissue in 3 (8.11%); none was associated with neurological symptoms, cement embolism, or infection.Recent fracture occurred adjacent to the formerly cemented ones in 2 patients (7.14%) and in non-adjacent level in one (3.57%). In conservative group, 3 patients (9.37%) presented with new osteoporotic vertebral fractures in adjacent levels and 2 (6.25%) in non adjacent levels. Three patients (9.37%) showed non union. Conclusion Percutaneous vertebroplasty is safe and effective in treatment of symptomatic chronic osteoporotic vertebral compression fractures with significantly better clinical and radiological outcomes when compared with conservative management.

Introduction: Sacral nonunion is a rare complication of vertically unstable sacral fractures. Patients present either after failed conservative treatment or as an overlooked injury in a polytrauma patient. Patients and Methods: We report the surgical treatment of 7 patients with sacral non-union. All were men with age ranged from 20 to 52 years. Six patients presented late (from 16 to 32 weeks) after failed conservative treatment. One patient presented 28 weeks after failed iliosacral screws fixation. Shortening (from 10 to 44 mm), pain and inability to walk were the presenting symptoms. Neurological complications were associated in 4 patients; three as sacral root injury and one with lumbosacral trunk palsy. Preoperative clinical as well as radiological assessment protocol was applied in all seven patients. The fracture was Denis type II (transforaminal) in 6 patients (transalar) and Denis type I in one. Open reduction through midline dorsal exposure was applied in all cases. Excision of fibrous tissue and freshening of fracture surface was done. Bone resorption with significant bone gap was found in 6 patients, for which autogenous iliac bone graft was used to avoid sacral narrowing and sacral root compression across the transforaminal fracture. Additional bone allograft was needed in one case after failed first grafting. Posterior lumbopelvic fixation was done in 4 patients, posterior sacral plating (small LCP) in one, ilio-iliac plate in addition to iliosacral fixation in two. Anterior pelvic ring release and stabilization was done in 4 patients, while anterior symphyseal plate fixation implant was present in one. One patient had associated complicated urological procedures hindering anterior fixation.

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This study pointed out that subtotal thyroidectomy is safe despite the late complication of recurrence and morbidity or reoperation .There is an obvious decrease in the rate of complications associated with total thyroidectomy ,especially with increasing experience and refinement of the surgical technique . Total extracapsular thyroidectomy is a safe and highly effective procedure in most patients ,with acceptable postoperative complications.

This study pointed out that subtotal thyroidectomy is safe despite the late complication of recurrence and morbidity or reoperation .There is an obvious decrease in the rate of complications associated with total thyroidectomy ,especially with increasing experience and refinement of the surgical technique . Total extracapsular thyroidectomy is a safe and highly effective procedure in most patients ,with acceptable postoperative complications.

This study pointed out that subtotal thyroidectomy is safe despite the late complication of recurrence and morbidity or reoperation .There is an obvious decrease in the rate of complications associated with total thyroidectomy ,especially with increasing experience and refinement of the surgical technique . Total extracapsular thyroidectomy is a safe and highly effective procedure in most patients ,with acceptable postoperative complications.

This study pointed out that subtotal thyroidectomy is safe despite the late complication of recurrence and morbidity or reoperation .There is an obvious decrease in the rate of complications associated with total thyroidectomy ,especially with increasing experience and refinement of the surgical technique . Total extracapsular thyroidectomy is a safe and highly effective procedure in most patients ,with acceptable postoperative complications.

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