Radiologists More Involved in Orthopedic Surgical Procedures

Today, rapid technical advances have made them ever more important co-players in the treatment process. Interventional radiology has been especially effective in treating osteoporosis and back pain.

"One of the biggest domains of interventional radiology is the treatment of osteoporosis and back pain,” explained Prof. Dr. Afshin Gangi, head of the radiological department at the University Hospital Strasbourg (France) at the annual meeting of the European Congress of Radiology (ECR 2007) held in Vienna, Austria, from March 9-13, 2007. "Today, technical progress allows us to remedy damage that was once virtually or completely inoperable. This can be done quite quickly and without undesirable side effects.”

Interventional radiology was a central topic at this year's ECR. Over the past 15 to 20 years, radiology has undergone changes more quickly than nearly any other medical discipline. Computer and magnetic resonance imaging (MRI) provides high-resolution insights into practically all structures of the human body. They are highly superior to conventional x-ray images, and increasingly enable clinicians to conduct minimally invasive surgery (key-hole procedures).

One of the most frequent consequences of osteoporosis is the partial fracture of the body of a vertebra. Conservatively, most of the older individuals affected by this disease simply obtain pain treatment and are instructed to stay in bed for three to six weeks. During this period, muscles atrophy and it becomes hard for patients to get back on their feet. In percutaneous vertebroplasty, special cement is injected into the patient through a 1-mm insertion hole. The procedure is MR-guided right to the area where the vertebra needs support. Pain disappears with the flick of a wrist, and the patient can leave after 48 hours. The superiority of this method was recently proven quite impressively in a large-scale study conducted by Dutch and Belgian scientists, led by Professor Dr. Maurits Voormolen at the University Hospital in Antwerp. A study by Prof. Giovanni Carlo Anselmetti and his colleagues at the Cancer Research Institute in Candiolo (near Turin, Italy) revealed that the procedure nearly always succeeds and has hardly any side effects when carried out correctly.

Balloon cyphoplasty is not used to treat osteoporosis, but is specifically suited for younger individuals with accident-related vertebral fractures entailing no nerve damage. In this procedure, a specially shaped balloon is inserted into a tiny hole at the spot where the vertebra collapsed. The balloon is slowly inflated over a period of 30 to 45 minutes until it matches the natural height of the vertebra. A special cement, with a calcium-phosphate base is injected into the cavity. Mechanically, it behaves like bone; it is reabsorbed by the body over time and replaced by real bone. The vertebra can be subjected to supporting weight after three days and patients save themselves weeks in bed in a cast.

Radiofrequency ablation (RFA) is very beneficial for individuals with osteoid osteomas (benign bone lesions) or bone metastases. Currently, a small key-hole is placed in the skin and a probe with an electrode on the end is inserted. The metastases and lesions are literally burned out of the bone. This is done so thoroughly that the removed material cannot attach itself elsewhere in the body and form new metastases. After about 12 hours, the patient is virtually free of discomfort.


Related Links:
European Congress of Radiology