CT-gestützte Analyse der Zementdistribution bei monopedikulärer Vertebroplastie

Walz, M.; Esmer, E.; Kolbow, B.

doi:10.1007/s00113-006-1180-8

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…Our results revealed a statistically insignificant difference of 4.42% between the median percentage height increases of the ipsilateral and contralateral sides (P = 0.171). To achieve a symmetrical increase in vertebral body height, we draw attention to the technical importance of using a medial cannula trajectory to ensure a precise device position in the mid-line or middle third of the vertebral body [10,23]. This is the optimal position for device expansion.…”

Section: Discussionmentioning

confidence: 99%

Results, experience and technical points learnt with use of the SKy Bone Expander kyphoplasty system for osteoporotic vertebral compression fractures: a prospective study of 40 patients with a minimum of 12 months of follow-up

et al. 2007

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To describe our centre's results, experience and technical points learnt with the SKy Bone Expander System for osteoporotic vertebral compression fractures (VCFs). Forty consecutive patients with painful single level T12 or L1 osteoporotic VCF who had failed conservative management for more than 3 months had 40 single level SKy Bone Expander kyphoplasties performed. Using local anaesthesia with patients in a prone, hyper-lordotic position, a unilateral, percutaneous, intra-pedicular approach was employed. Once correctly positioned, the SKy Bone Expander was expanded, creating a void. It was subsequently contracted, removed and bone cement injected. Pre-kyphoplasty and 12-month post-kyphoplasty radiological and functional outcomes were recorded. Statistical analysis was by Wilcoxon Signed Ranks Test. Median percentage increase in anterior, middle and posterior vertebral body heights at 12-month post-operative was 51.25% [inter-quartile range (IQR) 17.21-93.22], 52.29% (IQR 26.50-126.17) and 9.84% (IQR 4.94-19.26) respectively, while median percentage decrease in kyphotic angle was 30.77% (IQR 17.06-46.61). There was no significant vertebral body correction loss at 12-month post-operative. Visual analogue score, North American Spine Society and Short Form-36 scores for physical functioning and bodily pain scores improved by medians of 5.0 (IQR 3.0-8.0), 1.45 (IQR 0.68-2.90), 20.5 (IQR 0.0-40.8) and 10.0 (IQR 0.0-20.0) respectively. All P-values were <0.001. There were eight adjacent/remote level VCFs, three cases of cement extravasation and one case of the SKy Bone Expander being unable to be contracted and withdrawn from the vertebral body. It was left in situ. This is the first reported incidence of such a complication. The SKy Bone Expander System appears to be a viable alternative to balloon tamp kyphoplasty. Important technical considerations include proper device positioning within the vertebral body before expansion, single use of devices, familiarity with salvage procedure and injection of bone cement under close image intensifier guidance to prevent cement extravasation.

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Section: Discussionmentioning

confidence: 99%

Results, experience and technical points learnt with use of the SKy Bone Expander kyphoplasty system for osteoporotic vertebral compression fractures: a prospective study of 40 patients with a minimum of 12 months of follow-up

et al. 2007

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“…Furthermore, our results revealed the possibility of a biomechanical balance through unipedicular PKP, as long as the cement augmentation is able to cross the midline and fill the non-punctured side adequately. Thus, for facilitating excellent cement augmentation using unipedicular PKP, we should aim to improve our instruments for puncturing the VB [5,13] and guiding equipment [22].…”

Section: Reasons For Choosing Stiffness As the Biomechanical Parametermentioning

confidence: 99%

Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae

Chen

Xie³

et al. 2011

Eur Spine J

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Percutaneous kyphoplasty (PKP) has been used to treat osteoporotic vertebral compression fractures for over 10 years; however, clinically speaking it is still controversial as to whether the use of unipedicular PKP or bipedicular PKP is best. Our study aimed to compare the different effects of unipedicular PKP and bipedicular PKP on the stiffness of compression fractured vertebral bodies (VBs), as well as to assess how cement distribution affect the bilateral biomechanical balance of the VBs. During this study, 30 thoracic VBs were compressed, creating vertebral compression fracture models; then they were augmented by unipedicular (group A and B) PKP and bipedicular (group C) PKP. In group A (unipedicular PKP), the cement was injected into one side and the augmentation was limited to the same side of the VB. In group B (unipedicular PKP), the cement was injected at only one side but the augmentation extended across the midline and filled both sides of the VB. In group C (bipedicular PKP), the cement was injected into both sides and thus achieved the bilateral augmentation. For the unipedicular PKP, the amount of cement injected was 15% of the original VB volume; while in bipedicular PKP, the amount of cement injected was a total of 20% of the original VB volume (10% was injected into each side). Using a MTS-858, we examined three phases of the VBs (intact, pre-augmented, post-augmented), by applying loads axially to the total vertebra and bilateral sides of the vertebra for each of three cycles, respectively. The changes of force and displacement were then recorded and the stiffness of the total vertebra and bilateral sides of the vertebra were calculated. For the pre-augmentation stage, the total VB stiffness of groups A, B and C significantly decreased when the compression fracture models were established (P < 0.05). After the cement augmentation (the post-augmentation stage), both groups A and B, showed that the stiffness could be restored to the initial, intact state; however, in group C, the stiffness was significantly higher than the initial, intact state (P < 0.01). The stiffness of the augmented side of group A was significantly higher than the non-augmented side (P < 0.001). In groups B and C, no significant differences were observed in the stiffness between total VB and each individual side. Thus, we can conclude that both unipedicular PKP and bipedicular PKP significantly increase the total VB stiffness. Bipedicular PKP creates stiffness uniformly across both sides of the vertebrae, while unipedicular PKP, creates a biomechanical balance depending on the distribution of cement. If bone cement is augmented only on one side, the stiffness of non-augmented side will be significantly lower than the augmented side, which might lead to an imbalance of stress on the VB. However, when cement augmentation crosses the midline, stiffness of both sides increase comparatively and biomechanical balance is thus achieved.

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“…CT scan demonstrates axial views (4,5) to monitor the whole pathway of the needle in the pedicle of interest and readily detects cement leakage into the spinal canal with high-resolution power. Combined CT and fluoroscopy provides three-dimensional views including frontal, AP and lateral views and would be the best tool to monitor vertebroplasty theoretically.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive vertebroplasty managed by a two C‐arm fluoroscopic technique

Hsu

Cheng

et al. 2007

Minimally Invasive Therapy & Allied Technologies

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One C-arm fluoroscope is widely considered to be sufficient for effectively monitoring minimally invasive vertebroplasty. However, rotating the C-arm fluoroscope for different radiographic views of the spine can be time-consuming, causing delay in detecting cement leakage. We retrospectively reviewed the results of minimally invasive vertebroplasty utilizing two C-arm fluoroscopes in the treatment of osteoporotic vertebral fractures. Forty-two patients (50 vertebrae) were treated with minimally invasive vertebroplasty under the guidance of two C-arm fluoroscopes. The mean operation time, patient satisfaction rate and the incidences of cement leakage or infection were used to evaluate the feasibility and efficacy of the two C-arm fluoroscopic technique in performing minimally invasive vertebroplasty. The mean follow-up duration was 17.4 months (range 6 approximately 36). The mean operation time was 37+/-14 minutes. Thirty patients (71%) were very satisfied or satisfied with the procedure. Cement leakages were identified in nine patients (nine vertebrae, 18%). Only one vertebra had a posterior leakage into spinal canal, which did not cause neurologic deficits. No wound infection was observed. This study indicates that the two C-arm fluoroscopic technique provides simultaneous antero-posterior and lateral radiographic views, and therefore may reduce the operation time. No symptomatic cement leakage or wound infection was noted in this investigation. Moreover, no additional staff is needed to rotate the C-arm for fluoroscopy. The proposed technique has been shown to be effective and useful for performing minimally invasive vertebroplasty.

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CT-gestützte Analyse der Zementdistribution bei monopedikulärer Vertebroplastie

Cited by 8 publications

References 23 publications

Results, experience and technical points learnt with use of the SKy Bone Expander kyphoplasty system for osteoporotic vertebral compression fractures: a prospective study of 40 patients with a minimum of 12 months of follow-up

Results, experience and technical points learnt with use of the SKy Bone Expander kyphoplasty system for osteoporotic vertebral compression fractures: a prospective study of 40 patients with a minimum of 12 months of follow-up

Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae

Minimally invasive vertebroplasty managed by a two C‐arm fluoroscopic technique

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