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COMPREHENSIVE “PRIMARY CARE” VERTEBROPLASTY CLINIC IN A FREE-STANDING, RADIOLOGIST OWNED DIAGNOSTIC IMAGING CENTER-DIAGNOSTIC, TREATMENT, PREVENTION AND FOLLOW-UP OF VCFs. BY H. PAUL HATTEN, Jr., M.D. INDIAN RIVER RADIOLOGY VERO BEACH, FLORIDA, USA. DISCLOSURE. INDIAN RIVER COUNTY. - PowerPoint PPT Presentation
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COMPREHENSIVE “PRIMARY CARE” VERTEBROPLASTY CLINIC IN A FREE-STANDING,
RADIOLOGIST OWNED DIAGNOSTIC IMAGING CENTER-DIAGNOSTIC, TREATMENT, PREVENTION
AND FOLLOW-UP OF VCFs
BYH. PAUL HATTEN, Jr., M.D.INDIAN RIVER RADIOLOGY
VERO BEACH, FLORIDA, USA
DISCLOSURE
INDIAN RIVER COUNTY
•Full Time Population 141,667 (est. 2009)•Seasonal Population 163,531 (est. 2009)
INDIAN RIVER RADIOLOGY
Free Standing Diagnostic Imaging Center (DIC)
6,268 square feet4 Board Certified Radiolgists
EQUIPMENT
CT – Marconi MX 8000Fluoro
DEXA – GE LunarPlain Films
Ultrasound – Sequoia AcusonMRI – 1.0 Tesla Philips Open
OFFICE PROCEDURES
• SI Joint Injections• ESI’s
- CT Guidance• Bone Biopsies• Soft Tissue Biopsies
- CT- Ultrasound
VERTEBROPLASTIES
• HPH – CAQ Neuroradiology• Started Vertebroplasties 2000• 951 Vertebroplasties as of 8/31/2010
AMBULATORY SURGERY CENTER (ASC)
•Radiolgist helped organize and design•Siemens 23” C-Arm
New Technologies:
Novel Vertebroplasty Materials
CERAMENT™ Bi-Phasic Ceramic Bone Substitute:-
Enhances the bulk of cancellous bone:-
- Biologically
- Biomechanically
Bio-Material Characteristics 60 wt % α-calcium sulfate hemihydrate (CaS) 40 wt % hydroxyapatite (HA)
High injectability allows for minimal invasive delivery and ensures good intraosseal spread Iohexol-based radio-opacity enhancing component (liquid)
Makes the material visible under fluoroscopy
CERAMENT™ U.S.A. Pilot Results
•90% of 20 patients treated have complete pain relief •Pain improved from VAS 8.5 av. pre-op to 1.8 av. at one week •17 patients at 6 months with av. VAS of 1.2 •16 patients at 12 months with av. VAS of 0.6 •One adjacent level fractures to date 11 months post-surgery
At 12 weeks, there is extensive new bone formation, cement resorption, and cement incorporation in the bi-phasic ceramic-filled defect
CRITICAL DEFECT IN RABBIT
Empty Bi-Phasic Ceramic
C
CnB
nB
nB
Progression of Resorption of Cerament™ and Bone Incorporation beyond 1 year
Axial CT Scan, L1:Day 1
Axial CT Scan, L1:13 Months
Professional Bowler: Levels L3 & L4 Treated
Post Operative CT ScanPre Operative MRI
Returns to Professional Bowling in Las Vegas Tournament 14 days Post Cerament™ Vertebroplasty.
“PRIMARY CARE” VERTEBROPLASTY CLINIC
• Osteoporosis Counseling - Reclast Infusion Center - Calcium & Vitamin D• Vertebroplasty• Pain Management (no pain meds)
REQUEST
• Imaging• Pain Treatment - Vertebroplasty - ESI’s - SI Joint Injection - Facet Injections
PATIENT FOLLOW-UP
• RN Nurse Coordinator calls all pain management patients day following procedure.
• All Verterbroplasty patients called by Dr. Hatten evening of procedure.
• Any new pain and/or VCF call RN Nurse Coordinator.
OSTEOPOROSIS COUNSELING
• Vitamin D• Calcium• Bisphosphonate Treatment (Reduces
risk of VCF’s by 50%)
RECLAST INFUSION CENTER
• Initiated February 2009• Reclast (Zoledronic Acid – Novartis
Pharaceutical)• Annual Infusion
“PRIMARY CARE” VERTEBROPLASTY CLINIC
• VCF- Verebroplasty - Prevention- Follow-up- New VCF’s
• Spine Interventional Procedures- ESI’s- SI Joint Injections
• General Radiology Procedures