ABSTRACT
Percutaneous vertebral augmentation is the most commonly used minimally invasive surgery in the treatment of osteoporotic vertebral compression fractures(OVCF).The efficacy and safety have been widely recognized,however,there are still some complications of percutaneous vertebral augmentation.And the most common complication is bone cement leakage,which can lead to nerve root and spinal cord injury,increase the risk of secondary fractures of adjacent vertebral,and even cause serious complications such as pulmonary embolism.The diagnosis,classification,hazard,influence factors and preventive measures of bone cement leakage in vertebral augmentation for OCVF are reviewed in this paper,which will provide reference for prevention and treatment of bone cement leakage in clinical practice.
ABSTRACT
BACKGROUND:Currently, the cement delivery device used in vertebral augmentation vertebral augmentation (vertebroplasty and kyphoplasty) has flat tips that cannot be bent. During surgery, we always choose injection cement by symmetric way to keep the balance of power on the biomechanics of the vertebral body, while the traditional cement delivery tube can only be used in ipsilateral vertebral body. OBJECTIVE:To evaluate the feasibility of curved vertebroplasty device for the treatment of thoracolumbar osteoporotic vertebral compression fractures. METHODS: Sixty patients (72 vertebral bodies) with osteoporotic vertebral compression fractures were enroled, including 8 cases of double-level vertebral fractures and 2 cases of three-level vertebral fractures. Al operations applied curved delivery device in percutaneous vertebroplasty. We recorded operation time, intraoperative blood loss, and X-ray imaging data through prospective self control study. Treatment effect was evaluated with modified Oswestry disability index, Visual Analogue Scale scores and the World Health Organization Quality of Life assessment. The patients were folowed up for 6 months to 2 years. RESULTS AND CONCLUSION: (1) Surgery was performed successfuly on al 60 patients. The average operation time was 27 minutes (20-45 minutes) for 50 cases by unilateral transpedicular approach. (2) The mean amount of bone cement in every single vertebral of al 72 vertebrae was averagely 6.4 mL (4.2-9.5 mL). Bone cement distribution had not been found to be biased one-sided without severe leakage. (3) Visual Analogue Scale score and Oswestry disability index were significantly improved at 1 day after treatment (P 0.05). (4) The ratio of good quality of life in 1 month than postoperatively (87%) and in the last folow-up (92%) was significantly greater compared with the preoperative ratio (27%) (P < 0.05). (5) These findings confirmed that curved vertebroplasty device in unilateral pedicle puncture could ensure bilateral symmetric distribution of bone cement. Al patients are satisfied with treatment. It is proved to be a feasible simple and safe method.