General Session: Tumor, Trauma, and Infection
Presented by: I. Zidan - View Audio/Video Presentation (Members Only)
(1) Faculty of Medicine, Alexandria University, Neurosurgery, Alexandria, Egypt
Introduction: Percutaneous vertebroplasty is a minimally invasive procedure designed to treat various spinal pathologies as osteoporosis, metastasis and vertebral hemangiomas in order to reduce pain and allowing early ambulation. The maximum number of levels to be injected at one setting is still debatable.
Objective: This study was done to evaluate the usefulness and safety of multilevel percutaneous vertebroplasty (more than three vertebrae) in management of osteoporotic fractures.
Methods: This prospective study was carried out on consecutive 20 patients with osteoporotic fractures who had been operated for multilevel percutaneous vertebroplasty (more than three levels). This study was done in Alexandria Main University hospital over a period of five years starting from June 2010 to June 2015. There were 14 females and six males and their ages ranged from 60 to 85 years with mean age of 72.5 years. As regards the clinical presentation, all patients had presented with back pain before surgery. All patients had preoperative plain X-ray, CT and MRI examination. Ninety seven vertebrae were injected in those twenty patients (4 levels in eight patients, 5 levels in 7 patients and six levels in five patients). Vertebroplasty included 70 lumbar vertebrae and 27 dorsal vertebrae. Unilateral transpedicular injection wasdone in 62 vertebrae. All patients were evaluated immediate post vertebroplasty and then every six months. Visual analogue scale (VAS) was used for pain intensity measurement and plain X-ray films and CT scan were used for radiological assessment. The mean follow-up period was 21.7 months (range, 12-40 months) including both clinical and radiological examinations.
Results: No cases with symptomatic bone cement leakage were recorded in the present study. Symptomatic pulmonary embolism was observed in one patient. Significant improvement of pain (defined as decrease of VAS scores of more than 50%) was recorded immediate postoperative in eighteen patients (90%). Still better improvement than the postoperative baseline in later follow up however not significant. Good restoration of vertebral height was recorded in 85% of the patients after one year.
Conclusion: multilevel percutaneous vertebroplasty for the treatment of osteoporotic fractures is a safe and successful procedure that can significantly reduce pain and improve patient's condition without a significant morbidity. It is considered a cost effective procedure allowing a rapid restoration of patient mobility.
Keywords: percutaneous vertebroplasty, osteoporotic fractures, bone cement, multilevel injection