Transcript indian river radiology

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
•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 feet
4 Board Certified Radiolgists
EQUIPMENT
CT – Marconi MX 8000
Fluoro
DEXA – GE Lunar
Plain Films
Ultrasound – Sequoia Acuson
MRI – 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
• Short term strength
• Resorbable during 612 months
• Long term support
• Highly
osteoconductive
CaS
HA
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
CRITICAL DEFECT IN RABBIT
nB
C
nB
Empty
C
Bi-Phasic Ceramic
nB
At 12 weeks, there is extensive new bone formation, cement resorption, and
cement incorporation in the bi-phasic ceramic-filled defect
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
Pre Operative MRI
Post Operative CT Scan
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