Evaluation of anesthesia methods in percutaneous kyphoplasty procedures in vertebral compression fractures

Abstract

Aim: Kyphoplasty is a much less invasive technique than conventional methods to strengthen vertebral body fractures. This study aimed to demonstrate a safe and effective anesthesia method by retrospectively investigating the clinical conditions, perioperative pain experiences, and anesthesia methods of patients who underwent kyphoplasty in our institution. Material and Method: A total of 76 patients who had kyphoplasty operations performed under elective conditions between January 2018 and March 2021 have been enrolled in this research. Demographic data of patients, injury mechanisms, anesthesia method, duration of surgery, severe perioperative complications (heart attack, lung disease, delirium, etc.), duration of postoperative stay in intensive care, pre and postoperative pain degrees with visual analogue scale (VAS) has been interpreted. Results: There was a statistically significant difference between the groups in terms of duration of operation, duration of anesthesia, postoperative discharge time, postoperative 24-hour VAS score, intraoperative hemodynamic status, and presence in the post-anesthesia care unit (PACU) (p<0.05). The operation time, anesthesia time, postoperative discharge time, and the postoperative 24-hour VAS score of individuals with general anesthesia were higher than those under local anesthesia and sedation. Regarding intraoperative hemodynamic status, 37.5% of those under general anesthesia were stable, while 73.5% of individuals under local anesthesia and sedation were stable. While 37.5% of those under general anesthesia were in the post-anesthesia care unit, this rate was 7.4% in those under local anesthesia and sedation. Conclusion: The most appropriate anesthesia type should be determined according to the patient’s individual health status. Each method has its advantages, such as no need for a stable position in general anesthesia and availability of motor functioning evaluation and verbal communication in local anesthesia; hence local anesthesia and sedoanalgesia were together. This seems to be more advantageous with the appropriate sedation.

Keywords

• Kyphoplasty
• vertebral fractures
• general anesthesia
• PACU

Supporting Institution

kurum yok

References

1. Briot K, Kolta S, Fechtenbaum J, et al. Increase in vertebral body size in postmenopausal women with osteoporosis. Bone 2010; 47: 229-34.
2. Iolascon G, Moretti A, Giamattei MT, et al. Prevalent fragility fractures as risk factor for skeletal muscle function deficit and dysmobility syndrome in post-menopausal women. Aging Clin Exp Res 2015; 27: 6-11.
3. Deandrea S, Lucenteforte E, Bravi F, et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010; 21: 658-68.
4. Müller CW, Gösling T, Mameghani A, et al. Vertebral fractures due to osteoporosis. Kyphoplasty and vertebroplasty vs conservative treatment. Orthopade 2010; 39: 417-24.
5. Iolascon G, Cisari C, Moretti A, et al. NSAIDs and opioids in management of fragility fractures. Aging Clin Exp Res 2013; 25: 97-100.
6. Migliaccio S, Francomano D, Romagnoli E, et al. Persistence with denosumab therapy in women affected by osteoporosis with fragility fractures: a multicenter observational real practice study in Italy. J Endocrinol Investig 2017; 40: 1321-6.
7. Migliaccio S, Resmini G, Buffa A, et al. Evaluation of persistence and adherence to teriparatide treatment in patients affected by severe osteoporosis (PATT): a multicenter observational real life study. Clin Cases Miner Bone Metab 2013; 10: 56-60.
8. Zhu RS, Kan SL, Ning GZ, et al. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network metaanalysis. Osteoporos Int 2019; 30: 287-98.

9. Ru XL, Jiang ZH, Song BS, Treatment of senile osteoporotic vertebral compression fractures with percutaneous kyphoplasty under local anesthesia. Zhong guo Gu Shang 2013; 26: 824-8.
10. Jie Liu, Lin Wang, Mei Chai, et al. Analysis of anesthesia methods in percutaneous kyphoplasty for treatment of vertebral compression fractures. J Healthc Eng 2020: 3965961.
11. Luginbühl M. Percutaneous vertebroplasty, kyphoplasty and lordoplasty: implications for the anesthesiologist [J]. Curr Opin Anaesthesiol 2008; 21: 504-13.
12. Key BM, Symanski J, Scheidt MJ, Tutton SM. Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral AugmentationSemin. Musculoskelet Radiol 2021; 25: 785-794.
13. Chen WC, Tsai SHL, Goyal A. Comparison between vertebroplasty with high or low viscosity cement augmentation or kyphoplasty in cement leakage rate for patients with vertebral compression fracture: a systematic review and network meta-analysis. Eur Spine J 2021; 30: 2680-90.
14. Razek AA, Ashmalla GA. Assessment of paraspinal neurogenic tumors with diffusion-weighted MR imaging. Eur Spine J 2018; 27: 841-6.
15. Staender SEA, Mahajan RP. Anesthesia and patient safety: have we reached our limits? Curr Opin Anaesthesiol 2011; 24: 349-53.
16. Urman RD, Punwani N, Shapiro FE. Patient safety and office-based anesthesia. Curr Opin Anaesthesiol 2012; 25: 648-53.
17. Tosi F, Genovese O, Jovanovic T, Visocchi M. Management of Anaesthesia. Acta Neurochir Suppl 2019; 125: 381-6.
18. Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br) 2003; 85: 83-9.
19. Harrington KD. Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate : a case report. J Bone Joint Surg Am 2001; 83: 1070-3.
20. Park JW, Park SM, Lee HJ, et al. Infection following percutaneous vertebral augmentation with polymethylmethacrylate. Arch Osteoporos 2018; 13: 47.
21. Razek AA, Sherif FM. Diagnostic accuracy of diffusion tensor imaging in differentiating malignant from benign compressed vertebrae. Neuroradiology 2019; 61: 1291-6.