Kyriakos Kakavelakis

Aim: Presentation of the technique, the mistakes and the results of a new minimal invasive surgical procedure for reduction and augmentation of pathological fractures of the vertebrae in spine. Patients and Methods: 12 patients (2 men / 10 women) with mean age 68 years (54–73) with pathological vertebral underwent kyphoplasty. The mean pain according to VAS was 7, 3 (6–10) and the mean follow up time is 8 months (5–14). 11/12 patients (20 vertebrae) had osteoporotic vertebral and 1/12 (1 vertebra) had metastatic lesion. 8/21 vertebrae were in thoracic spine and 13/21 in lumbar spine. In 20/21 the procedure was transcervical to the vertebra and in 1/21 was out of the cervix. 11/12 patients had kyphotic deformity in the plain x-ray and 18/21 vertebrae had decreased their height. To all patients was spilled PMMA. Results: 10/12 patients referred degrease of their pain in the first 48 hours and 2/12 in the 5th postoperative day. Correction of the kyphotic deformity was observed in 11/12 and reduction of the reduction of the fracture was occurred in 16/21 vertebrae. Leakage of PMMA was occurred in 5/21 vertebrae; in 2/5 the leakage was in the canal, in 1/5 in the intervertebral space and in 2/5 out of the vertebrae. 1/12 patient 2 moths postperatively had another vertebral fracture in a lower vertebra that was deled again with kyphoplasty. None of the patients had neurological deficit postoperatively. According to Oswestry questionnaire all the patients referred return to all their before fracture daily activities. Conclusions: Kyphoplasty in pathological vertebral fractures has as a result the immediate decrease of the pain and the return of the patient to his/her daily activities. Also there is correction of the kyphotic deformity decreases the possibility of a new vertebral fracture and the establishment of chronic back pain.

The evaluation of results following posterior decompression and fusion for the management of cervical spondylotic myelopathy Between July 2006 and May 2008, 68 patients with cervical myelopathy underwent posterior decompression with laminectomies and pedicle screw fixation of the cervical spine. All patients were selected based on the presence of multi-level degenerative disease and the correction of cervical lordosis on the pre-operative dynamic radiographs. Patient demographics, co-morbidities and post-operative complications were recorded and analysed. Functional outcome was assessed by using the Japanese Orthopaedic Association (JOA) score. There were 37 male and 31 female patients with an average age 67.4 years. The average follow up period was 18 months. The mean pre-operative JOA score was 8.7, whereas the mean post-operative score was 12.1 on the latest follow-up visit. 9 patients had unsatisfactory clinical results and consequently underwent anterior procedures with significant improvement. Complications included 1 epidural haematoma, 2 superficial infections and 4 cases of myofascial pain. In three cases there was mild dysfunction of the C5 nerve root which resolved spontaneously with conservative measures. In the present series of patients posterior decompression with laminectomies is an effective method for the management of cervical spondylotic myelopathy.

The circulatory effects of multilevel balloon kyphoplasty (BK) are not adequately addressed, neither the effectiveness of egg shell cementoplasty in preventing anticipated cement leakage in difficult cases. The purpose of this study was to evaluate the effect of multilevel BK to blood pressure and arterial blood gasses; the incidence of methylmethacrylate cement leakage using routine postoperative computer tomography scan and the effectiveness of egg shell cementoplasty to prevent cement leaks. Materials and methods: This is a prospective study of 89 patients (215 vertebral bodies-VBs) with osteoporotic compressive fractures (OCF), and 27 with osteolytic tumors (OT) (88 VBs). The mean age was 67.6 years. 27 patients with OCF were treated at one level, 26 at two, 21 at three, 7 at four, 6 at five, and 2 at six levels at the same sitting. Three patients with OT were treated at one level, 6 at two, 9 at three, 3 at four, 4 at five, and 2 at seven. Egg shell balloon cementoplasty to prevent cement leakage was performed in 10 patients with severe endplate fracture or vertebral wall lytic destruction. Arterial blood pressure and oxygen saturation were monitored during surgery. Arterial blood gases were measured before and 3 min after cement injection. Cement leakage was assessed by the postoperative x rays and computer tomography scans. Results: A drop in blood pressure of more than 25mmHg during cement injection was observed in 6 patients, and was not associated with the number of VB treated. Blood pressure was dropped more than 40mm in 2 patients and the procedure was aborted after completing 1 level in the first and 2 levels in the second. Drop in arterial O2 saturation was noted in 4 patients. One patient treated for 5 levels developed fever and tachepnoea for 24 hours after surgery. Arterial O2 and chest x-rays were normal. Cement leakage was found in 9.7% (21/215) of VBs treated for OCF. Its incidence per location was: epidural, 0.9% (2 VBs); intraforaminal, 0.5% (1 VB); intradiscal, 3.2% (7 VBs); and through anterior or lateral walls, 5.1% (11 VBs). In the OT group cement leakage was found in 10.2% (9/88) of the treated VBs. Its location included 8 (9%) through the anterior or lateral walls and one (1.1%) intradiscal. Cement leakage had no clinical consequences. No cement leakage was observed in cases treated with egg shell balloon cementoplasty. Conclusions: BK is a safe procedure when applied for multiple levels in the same sitting, and its rare circulatory effects are not related to the number of levels treated. The incidence of cement leakage in this study was 10%, which is far less than that reported with vertebroplasty using routine postoperative CT scan. Egg shell balloon cementoplasty can effectively minimize cement leakage in cases with fractured endplate or lytic destruction of VB walls.

Aim: Presentation of the technique, the mistakes and the results of a new minimal invasive surgical procedure for reduction and augmentation of pathological fractures of the vertebrae in spine. Patients and Methods: 12 patients (2 men / 10 women) with mean age 68 years (54–73) with pathological vertebral underwent kyphoplasty. The mean pain according to VAS was 7, 3 (6–10) and the mean follow up time is 8 months (5–14). 11/12 patients (20 vertebrae) had osteoporotic vertebral and 1/12 (1 vertebra) had metastatic lesion. 8/21 vertebrae were in thoracic spine and 13/21 in lumbar spine. In 20/21 the procedure was transcervical to the vertebra and in 1/21 was out of the cervix. 11/12 patients had kyphotic deformity in the plain x-ray and 18/21 vertebrae had decreased their height. To all patients was spilled PMMA. Results: 10/12 patients referred degrease of their pain in the first 48 hours and 2/12 in the 5th postoperative day. Correction of the kyphotic deformity was observed in 11/12...

The evaluation of results following posterior decompression and fusion for the management of cervical spondylotic myelopathy Between July 2006 and May 2008, 68 patients with cervical myelopathy underwent posterior decompression with laminectomies and pedicle screw fixation of the cervical spine. All patients were selected based on the presence of multi-level degenerative disease and the correction of cervical lordosis on the pre-operative dynamic radiographs. Patient demographics, co-morbidities and post-operative complications were recorded and analysed. Functional outcome was assessed by using the Japanese Orthopaedic Association (JOA) score. There were 37 male and 31 female patients with an average age 67.4 years. The average follow up period was 18 months. The mean pre-operative JOA score was 8.7, whereas the mean post-operative score was 12.1 on the latest follow-up visit. 9 patients had unsatisfactory clinical results and consequently underwent anterior procedures with signifi...

The circulatory effects of multilevel balloon kyphoplasty (BK) are not adequately addressed, neither the effectiveness of egg shell cementoplasty in preventing anticipated cement leakage in difficult cases. The purpose of this study was to evaluate the effect of multilevel BK to blood pressure and arterial blood gasses; the incidence of methylmethacrylate cement leakage using routine postoperative computer tomography scan and the effectiveness of egg shell cementoplasty to prevent cement leaks. Materials and methods: This is a prospective study of 89 patients (215 vertebral bodies-VBs) with osteoporotic compressive fractures (OCF), and 27 with osteolytic tumors (OT) (88 VBs). The mean age was 67.6 years. 27 patients with OCF were treated at one level, 26 at two, 21 at three, 7 at four, 6 at five, and 2 at six levels at the same sitting. Three patients with OT were treated at one level, 6 at two, 9 at three, 3 at four, 4 at five, and 2 at seven. Egg shell balloon cementoplasty to pre...

The purpose of the present study is to evaluate the attitudes and perceptions of healthcare professionals in the prefecture of Lasithi against the phenomenon of abused women, as well as their level of knowledge in identifying and managing the women-victims in a holistic way. Material Method A descriptive survey design was employed. Data was collected by using a self - administered questionnaire. The sample consisted of ninety one (91) health professionals (25 physicians and 66 medical nurses) working in pathology, surgery, orthopedic, maternity and emergency units of hospitals in the prefecture of Lasithi. Measures of central tendency and measures of dispersion (average value, standard deviation, range) were implemented for continuous variables, while discrete variables and clustered data were expressed as percentages. Results The findings reveal that health professionals believe that the psychological consequences of violence against women affect more the victims themselves (mean 4...

Ventriculoperitoneal shunting (VPS) is the standard treatment of hydrocephalus in children but can be followed by various intraabdominal complications. Formation of a cerebrospinal fluid (CSF) pseudocyst is a rare VPS complication. A case of a non-infected CSF pseudocyst complicated with acute appendicitis is presented.

Omphalocele is a disease of neonatal age and its present management is successful in almost all specialized centers of Pediatric Surgery. A case of an 8-year-old girl who was managed with conservative treatment during her neonatal period with mercurochrome (Grob method) is presented. Due to very serious congenital cardiopathy, a corrective operative procedure of the omphalocele was not feasible during neonatal age. However, following successful heart surgery the child grew up with her initial disorder. The child was first seen in our clinic at the age of 5 years, presenting with a very large omphalocele. Following a staged pressure of the abdomen with a special belt an attempt was made to close the ventral hernia successfully using a Gore-tex sheet.

Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.

A prospective study of soccer injuries, involving 287 male youth players, from the ages of 12-15 was conducted in 24 Greek soccer clubs, during the course of one year. A total of 193 players sustained 209 injuries. The incidence of injuries was 4.0 injuries per 1000 h of soccer time per player, and the most common types of injuries were sprains and strains. Surprisingly, it was found that an increase of injury incidences occurred during practice. Fifty-eight injuries required medical assistance. The majority of injuries (80%) were located in the lower extremities. Collision with other players was the most common activity at the time of injury, accounting for 40% of all injuries. The conclusion of this study and the evidence from other studies suggests that youth soccer is a relatively low risk sport. However, a substantial amount of injuries could be prevented. It is necessary to identify the risk factors, which are associated with these types of injuries.