The Journal of the American Academy of Orthopaedic Surgeons
-
J Am Acad Orthop Surg · Oct 2014
ReviewVertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures.
Vertebroplasty and kyphoplasty have been used to treat osteoporotic compression fractures for many years. In 2009, two randomized controlled trials demonstrated limited effectiveness of vertebroplasty over sham treatment; thus, the American Academy of Orthopaedic Surgeons published evidence-based guidelines recommending "against vertebroplasty for patients who present with an osteoporotic spinal compression fracture." However, several other trials have since been published that contradict these conclusions. A recent meta-analysis cited strong evidence in favor of cement augmentation in the treatment of symptomatic vertebral compression fractures.
-
J Am Acad Orthop Surg · Oct 2014
ReviewApproach to pain management in chronic opioid users undergoing orthopaedic surgery.
Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. ⋯ Patients using high levels of opioids may also require referral to an addiction specialist. Various regional blockade and pharmaceutical options are available to help control perioperative pain, and a multimodal pain management approach may be of particular benefit in chronic opioid users undergoing orthopaedic surgery.