_following Vertebroplasty Spinal Surgeon经皮椎体成形术后并发症后脊柱外科医生课件.ppt

Vertebroplasty A technique of Percutaneous Injection under Fluoroscopic Guidance of Methyl Methacrylate polymer into a weakened Vertebral body to relieve pain. Vertebroplasty Originated in France – 1986 70-90% pain relief 1% risk of complications The Osteoporotic Vertebral Fracture Advantages of Vertebroplasty Provides rapid reduction of Pain which has been resistant to Drug treatment. Bone strengthening Prevention of Vertebral Collapse Less Invasive than conventional surgery Patient Selection Within 4 months of fracture Axial midline pain refractory to conservative measures Increased on loading Local tenderness over spinous process MRI shows altered signal in body 2/3 of fractures are painless Results Significant pain relief is seen in 75-90% of osteoporotic fractures And in 59-86% of malignant fractures. Increased mobility Reduced analgesic requirement Results are sustained over time Mechanism of Pain Relief Destruction of sensitive nerve endings by mechanical, chemical and thermal forces. Stabilization of microfractures and reduction of destabilizing mechanical forces. Guide wire insertion Complications - < 10% Neuralgia Infection Cord compression Pulmonary Embolism Vascular injury - haematoma Rib fractures CSF leakage Hypotension Increased pain Vertebroplasty--Complications Incidence of complications is greater in Metastatic lesions as compared to Osteoporotic vertebral fractures. Vertebroplasty-Results 47 patients 92 vertebral levels Osteoporosis-39 Metastatic tumours-10 Ca. lung, Multiple myeloma Renal Cell Ca., Transitional cell Ca. Lymphoma Vertebroplasty-Results 90% had significant relief in pain Sustained pain relief Vertebroplast-Results 5 Patients-Transpedicular Biopsy and simultaneous Vertebroplasty through opposite pedicle Lymphoma(Diagnosed on Biopsy) Osteoporotic fracture(h/o of Uterine & Breast Ca.ruled out) Thank you * * * * * *