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BY H. PAUL HATTEN, Jr., M.D. INDIAN RIVER RADIOLOGY VERO BEACH, FLORIDA, USA

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.

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BY H. PAUL HATTEN, Jr., M.D. INDIAN RIVER RADIOLOGY VERO BEACH, FLORIDA, USA

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  1. 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

  2. DISCLOSURE

  3. INDIAN RIVER COUNTY Full Time Population 141,667 (est. 2009) Seasonal Population 163,531 (est. 2009)

  4. INDIAN RIVER RADIOLOGY Free Standing Diagnostic Imaging Center (DIC) 6,268 square feet 4 Board Certified Radiolgists

  5. EQUIPMENTCT – Marconi MX 8000FluoroDEXA – GE LunarPlain FilmsUltrasound – Sequoia AcusonMRI – 1.0 Tesla Philips Open

  6. OFFICE PROCEDURES • SI Joint Injections • ESI’s - CT Guidance • Bone Biopsies • Soft Tissue Biopsies - CT - Ultrasound

  7. VERTEBROPLASTIES • HPH – CAQ Neuroradiology • Started Vertebroplasties 2000 • 951 Vertebroplasties as of 8/31/2010

  8. AMBULATORY SURGERY CENTER (ASC) • Radiolgist helped organize and design • Siemens 23” C-Arm

  9. New Technologies: Novel Vertebroplasty Materials

  10. CERAMENT™ Bi-Phasic Ceramic Bone Substitute:-Enhances the bulk of cancellous bone:-- Biologically - Biomechanically

  11. 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

  12. 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

  13. CRITICAL DEFECT IN RABBIT nB C nB C Empty 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

  14. Progression of Resorption of Cerament™ and Bone Incorporation beyond 1 year Axial CT Scan, L1: Day 1 Axial CT Scan, L1: 13 Months

  15. Professional Bowler: Levels L3 & L4 Treated Returns to Professional Bowling in Las Vegas Tournament 14 days Post Cerament™ Vertebroplasty. Post Operative CT Scan Pre Operative MRI

  16. “PRIMARY CARE” VERTEBROPLASTY CLINIC • Osteoporosis Counseling - Reclast Infusion Center - Calcium & Vitamin D • Vertebroplasty • Pain Management (no pain meds)

  17. REQUEST • Imaging • Pain Treatment - Vertebroplasty - ESI’s - SI Joint Injection - Facet Injections

  18. 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.

  19. OSTEOPOROSIS COUNSELING • Vitamin D • Calcium • Bisphosphonate Treatment (Reduces risk of VCF’s by 50%)

  20. RECLAST INFUSION CENTER • Initiated February 2009 • Reclast (Zoledronic Acid – Novartis Pharaceutical) • Annual Infusion

  21. “PRIMARY CARE” VERTEBROPLASTY CLINIC • VCF - Verebroplasty - Prevention - Follow-up - New VCF’s • Spine Interventional Procedures - ESI’s - SI Joint Injections • General Radiology Procedures

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