Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

Abstract

Purpose The purpose of this study is to evaluate the effects of multilevel balloon kyphoplasty (BK) on blood pressure, blood gases and cement leakage. Methods This is a prospective study of 63 patients: 31 were treated for osteoporotic vertebral compressive fractures (OVCF) and 32 for osteolytic tumors (OT). Twentysix patients were treated at 1 level, 15 at 2, 2 at 3, 6 at 4, 3 at 5, 4 at 6, 5 at 7 and 2 at 8. PPMA was used in 43 patients and calcium phosphate in 20. All patients were treated under general anesthesia with continuous invasive monitoring of hemodynamic changes, arterial blood gases and peripheral and regional cerebral oxygen saturation.Results Two patients had a transient drop in blood pressure between 21 and 42 % during simultaneous inflation of all four balloons at two levels and three more patients during cement injection (two PMMA, one calcium phosphate). Five patients had a cement leak (7.9 %), which was unrelated to the cement type or number of levels. Blood pressure, end-tidal carbon dioxide partial pressure and arterial oxygen partial pressure decreased statistically, but without any clinical significance after cement insertion. Peripheral and regional cerebral oxygen saturation remained unchanged. One-way ANOVA revealed no difference between these changes when clustered by the groups single level, two levels and three or more levels. Conclusion BK performed under general anesthesia appears to be safe when applied in multiple levels in the same seating provided the balloons are inflated sequentially and not simultaneously and the cement is inserted slowly in a very doughy state. Close monitoring of cardiorespiratory factors is valuable. Its rare circulatory effects are unrelated to the number of levels or the cement type.

Percutaneous intervertebral bridging cementoplasty for adjacent multilevel osteoporotic thoracolumbar fractures with vertebral endplate-disc complex injury: technical note

“…It was possibly closely associated with vertebral endplate-disc injury in adjacent disc space and extrapedicular puncture for intervertebral space. The cement leakage ratio was similar to previous studies about cement augmentation for severe vertebrae fractures 23,24 . In our study, fortunately, the leakages were clinically asymptomatic.…”

Analysis of Related Factors on the Vertebral Height Restoration of Percutaneous Vertebral Augmentation

“…Some studies reckon that multilevel treatment in a single session has been shown to be feasible with no compromise of the technique's safety and efficacy and PVA is an efficient and safe technique for symptomatic vertebral fractures independently of the vertebrae number treated per session [15,16]. However, through multivariate linear regression analysis, we found in this study that the number of treated vertebrae is an important factor influencing the postoperative vertebral body height restoration.…”

Neurological deficit due to cement extravasation following a vertebral augmentation procedure

“…31 Some authors recommend performing these procedures with patients under local anesthesia to enable early detection of neurological compromise, 26 while others recommend general anesthesia for cardiorespiratory management, improved ability to obtain static images, and earlier intervention should clinically significant extravasation be suspected intraoperatively. 24 Obvious limitations of our review include the nature of the articles included, which represent relatively low levels of evidence. In many instances, case reports did not include all the information that we sought to extract.…”