Analysis of percutaneous kyphoplasty under different types of anesthesia for the treatment of multiple osteoporotic vertebral fractures

Abstract

Background Surgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs. Methods A retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups. Results The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups. Conclusion PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.

Effect of Different Anesthesia and Puncture Methods of Percutaneous Kyphoplasty on More Than 90-Year-Old Osteoporotic Vertebral Fracture: Advantages of the ERAS Concept

“…For multiple vertebral fractures, local anesthesia might not be suitable for all patients with OVF. Some researchers believe that general anesthesia has more advantages than local anesthesia [ 40 ]. In addition, to highlight the advantages and disadvantages of the two anesthesia methods, we only considered anesthesia-related complications and did not consider postoperative complications related to PKP surgery.…”

Anaesthetic considerations for high-risk patient kyphoplasty

“…On the other hand, general anaesthesia reduces the discomfort for patients with compressive vertebral fractures during positioning to the prone position as well as perioperatively. The use of general anaesthesia has been described to achieve better outcomes of kyphosis correction as well as recovery of the vertebral body size and confi guration as compared to local anaesthesia (5).…”

Can additional intravertebral anesthesia improve the intraoperative tolerance to percutaneous kyphoplasty for acute osteoporotic thoracolumbar fractures?

“…[1][2][3][4] Local anesthesia (LA) and general anesthesia (GA) are widely used for PKP. [5][6][7][8][9][10] However, there is ongoing controversy regarding the best anesthesia modality for PKP, and research on this topic is sporadic. Surgeons prefer to perform PKP under LA for the following reasons: it is less expensive than GA; allows real-time monitoring of nerve function; enables timely detection of spinal cord compression due to puncture or bone cement leakage; helps to avoid multiple organ dysfunction, which is seen in older adults after GA without postoperative resuscitation; and accelerates postoperative rehabilitation.…”

“…Surgeons prefer to perform PKP under LA for the following reasons: it is less expensive than GA; allows real-time monitoring of nerve function; enables timely detection of spinal cord compression due to puncture or bone cement leakage; helps to avoid multiple organ dysfunction, which is seen in older adults after GA without postoperative resuscitation; and accelerates postoperative rehabilitation. 7 However, surgery may need to be terminated because of unbearable pain. The facet joint capsule is richly supplied by nerves and receptors sensitive to physical stretching.…”