經(jīng)皮椎體成形術的技術方面的問題

1、Technical Aspects of Percutaneous Vertebroplasty,Dr. Cosme ArgerichNeurosurgeon,History,1987: First description by Galibert and Deramond.2019: First procedure in Geneva (Switzerland).2019 First reported procedure in U

2、SA.,Schools,European38% methastases31% Hemangiomas / Myelomas31% Osteoporosis,North American70% Osteoporosis17% Hemangiomas / Myelomas13% Methastases,DemographyUSA,10 Million cases of Osteoporosis (45% white femal

3、e > 50 years).700 thousand vertebral fractures / year.150 thousand hospital admissions / year.Total direct costs: U$ 13.800 Millions.Estimated costs in 2030: 60.000 Millions.,Diagnostic Sequence,Indications for PV

4、,Pain / instability in:Osteoporotic collapse.Sub-acute traumatic collapse.Malignant vertebral tumors (Metastasis / Myeloma)Vertebral angiomas,Osteoporosis,Intense and persistent post fractural pain: 1 to 12 weeks evo

5、lution.Pain focused on spinal mid-line, related to diagnosed vertebral collapse.Absence / poor response to medical therapy (Alendronate, Calcium, Opiates).Quality of Life impairment due to opiates side effects.,Osteop

6、orosis,T1: signal reduction in D 12.,STIR: increased signal suggesting recent fracture.,Tumors,High risk of vertebral collapse.Intractable pain.Marked side effects to opiates: blurred vision, bladder / bowel disorders,

7、 confinement to bed rest.Palliative treatment in terminal patients.,Malignant Tumors,T1: signal reduction in vertebral body and posterior elements,+ C: increased signal,Note that:,Most of skeletal metastasis occur in sp

8、ine.Up to 10% of cancer patients present symptomatic spine metastasis.Course of local disease may be painful and invalidating.,General Exclusion Criteria,Local / systemic infection.Recent fracture of posterior vertebr

9、al wall.Coagulation disorders.Poor general conditions.Vertebral collapse > 80 – 90%.,Particular Exclusion Criteria,Osteoporosis.Adequate response to medical treatment.Lack of radiological progression of fracture.

10、,Cancer:Advanced systemic disease.Progression to spinal channel.,Vertebral Approaches(will vary according to surgeon’s specialty and experience),Cervical Spine: Anterior.Dorsal Spine: Transpedicular.Lumbar Spine

11、: Transpedicular. Lateral.,Alternative Approaches,Latero-transpedicular.Latero-antepedicular.Laterovertebral.,Equipment,Fixed “C” Arm,Advantages: Better image qualityEasier operation,Disadvantages:High ope

12、rational costsUse subject to availability,Mobile “C” Arm,Advantages:Low operational costsAvailability,Disadvantages:Lesser image qualityMore difficult operation,Immediate access to:CT Scan and / or RMI.ICU.Opera

13、ting Room.Must be available for the treatment of potential complications,Anestesia,Election will depend on surgeon’s experience and characteristics of patient.,Intraoperative Monitoring,EKG.O2 Saturation (early diagno

14、sis of pleural lesion).Pressurometry (occasional vagal raction).During Local Anesthesia, Oxygen mask will provide sensation of comfort to patient.,Main advantages of Local Anesthesia,Allows the surgeon to communicate

15、with the patient.Benefits:Early diagnosis of lesions (radicular / pleural) which might not be diagnosed otherwise.Determine cement injection speed.Anticipate corrective measures.Abort the procedure.,Video(Actual P

16、rocedure under Local Anesthesia),Conclusions,PV is a Minimally Invasive Procedure.Surgical Technique may be acquired in a short time.PV may be performed on outpatients.Excellent tolerance to Local Anesthesia.May be c