Non-Balloon Kyphoplasty with High Viscosity Cement: Short-Term Clinical Outcomes

Yıl 2018, Cilt: 10 Sayı: 1, 1 - 10, 01.04.2018

Aykut Akpınar Uzay Erdoğan Ali Osman Akdemir

Öz

Aim: Vertebral compression fractures VCF can lead to severe acute and chronic pain, impaired mobility, reduced quality of life, and an increased risk of mortality due to limited mobility. Percutaneous vertebroplasty VP and kyphoplasty KP are two vertebral augmentation procedures VAPs which are minimally invasive surgical options in the treatment of painful VCFs. Vertebral fractures may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the VP and KP procedures is to provide immediate pain relief for patients and restore the vertebral height lost due to the fracture. This study aims to evaluate KP in terms of pain, disability, and quality of life. Costeffective radiological variables i.e., vertebral height restoration and KP for cement extravasation and complications profile were analyzed. Unipedicular or bipedicular approaches were compared. Methods: Following an injury, the patients had conservative treatment of VCFs including bed-rest bracing and analgesics for four weeks. In 55 patients, a total of 83 vertebral fractures were present. The main causes were falling from a height, traffic accident, and malignancies. We used spinal anesthesia for all patients. Vertebral augmentation was done under fluoroscopy. Results: The mean age was 59.18 years SD16.13 . The rate of female population 56.4% and osteoporotic patients 54.5% was higher. Thoracolumbar junction T10-L2 fractures were the most common fractures of spinal column. L1 was the most often affected vertebra 24.09% . After VAP, pain scores of the patients statistically significantly decreased. Unipedicular or bipedicular approaches provided the same pain reduction. The pain scores of osteoporotic patients and preoperative and postoperative pain scores were higher than non-osteoporotic groups. Preoperative and postoperative pain scores of the female patients were higher than male patients. Seven patients 12.7% had cement leakages. Conclusion: Our study result suggest that the use of the optimal material to provide the optimal result for patient is at the discretion of the surgeon. Clinicians can take the advantage of increased working time. Creating cavity by using drill and curve curette or a balloon and high-viscosity cement under low pressure can minimize leakage complications.

Anahtar Kelimeler

Kyphoplasty, Cement, Spinal trauma, Visual Analogue Scale, Oswestry Disability Index

Yüksek Viskoziteli Çimentoyla Balon Kullanılmadan Yapılan Kifoplasti: Kısa Dönem Klinik Sonuçları

Öz

Amaç: Vertebra sıkışma kırıkları VSK ; şiddetli akut ağrı, kronik ağrı, hareketliliği kısıtlama, hayat kalitesini azaltma ve hareket kısıtlanmasından ötürü mortalite riskini artırmaya öncülük edebilir. Perkütan Vertebroplasti VP ve Kifoplasti KP , ağrılı VSK’da minimal girişimsel cerrahi seçenekleri olan iki vertebra yükseltme yöntemidir. Vertebra kırıkları; kırık etrafında akut ağrı, vertebra çökmesine bağlı yükseklik kaybı, omurga instabilitesi ve kifotik deformiteye sebep olabilir. VP ve KP işlemlerinin hedefi hızlıca hastaların ağrıdan kurtulması ve kırık nedeniyle oluşan yükseklik kaybını onarılmasıdır. Bu çalışma kifoplastinin; ağrı, hayat kalitesi ve yetersizlik gibi faktörler üzerine olan etkilerini değerlendirmek amacındadır. KP ve radyolojik değişkenler vertebra yükseklik onarımı, vb , çimento kaçakları ve komplikasyon profilleri ile analiz edildi. Tek veya iki taraflı pediküler yaklaşımlar karşılaştırıldı. Materyel ve Metod: Yaralanma sonrası VSK hastaları; 4 haftalık yatak istirahati, korse ve analjezik tedavi gibi konservatif tedaviler aldılar. 55 hastada toplam 83 vertebra kırığı mevcuttu. Yüksekten düşme, trafik kazası ve malignensiler ana nedenleriydi. Tüm hastalar için spinal anestezi uyguladı. Vertebra yükseltme işlemleri floroskopi altında yapıldı. Bulgular: Ortalama yaş 59.18 ±16.13 idi. Kadın hasta populasyonu % 56.4 ve osteoporotik hasta populasyonu % 54.5 yüksekti. Omurga sütununun kırıklarının en sık olduğu yer torakolomber kesişim noktasıydı. Lomber birinci vertebra en çok etkilenen vertebraydı %24.9 . Vertebra yükseltme işlemi sonrası hastaların ağrı skorları istatiksel olarak belirgin azaldı. Tek veya iki taraflı pediküler yaklaşımlar, aynı ağrı skoru düzelmesi sağladı. Osteoporotik hastaların operasyon öncesi ve sonrası ağrı skorları osteoporotik olmayan hasta grubundan daha yüksekti. Bayan hastaların operasyon öncesi ve sonrası ağrı skorları erkek hastalardan daha yüksekti. Yedi hastada çimento kaçağı oluştu. Sonuç: Çalışmamızın sonucu; hasta için en uygun sonuçları sağlamak için en uygun material ve yöntemin kullanılmasının cerrahın tercihinde olmasını önermektedir. Klinisyen, çalışma zamanını azaltmanın avantajlarını alabilir. Vertebrada balonla, dril ve küret yardımıyla kavite oluşturmak ve yüksek viskositeli çimentoyu düşük basınçla vermek, çimento kaçağı komplikasyonlarını minimuma indirebilir.

Anahtar Kelimeler

Kifoplasti, çimento, omurga travması, görsel analog skalası, Oswestry maluliyet göstergesi

Kaynakça

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