Akademik Veri Yönetim Sistemi
The 4th International Medical Congress of Izmir Democracy University (IMCIDU 2022) , İzmir, Türkiye, 9 - 11 Kasım 2022, sa.314, ss.194, (Özet Bildiri)
ID 314: Unilateral Parapedicular Balloon Kyphoplasty in Patients with Thoracolumbar Vertebral Fractures; Technical Note
ID 314: Mert Arslan1, Koray Ur1, Ceren Kızmazoğlu1 1Dokuz Eylul University Faculty Of Medicine Department Of Neurosurgery, Izmir, Türkiye mertarslandr@gmail.com
Abstract
Introduction: Vertebral collapse fractures, which are mostly caused by osteoporosis and metastatic diseases, are an important cause of morbidity and mortality in the elderly population. Ideal treatment for vertebral fracture; It should provide rapid relief of symptoms with minimal invasion, prevent and/or correct the development of kyphosis, and prevent new fractures. In recent years, percutaneous balloon kyphoplasty procedure has been frequently used in the treatment of these patient groups. Kyphoplasty is often performed bilaterally and transpedicularly. In this study, our aim is to present the clinical results of patients with thoracolumbar spine fracture who underwent balloon kyphoplasty with unilateral parapedicular technique.
Method: Operations were performed under local anesthesia or sedoanalgesia. In this way, the operation was performed by providing cooperation with the patient during the operation and by controlling the motor movements at certain intervals. The patients were placed in a prone position, the surgical area was covered sterile, and after appropriate anesthesia was administered, the lesion level was determined by taking anteroposterior and lateral images with bidirectional C-arm fluoroscopy. The location of the pedicle was determined with the help of a needle just before making the skin incision. A small incision was made 3 cm lateral to the fixed pedicle with the help of a number 11 scalpel, and the cannula trocar system was inserted through this incision and advanced to the periosteum. The trocar is moved back and forth to the pedicle and rotated to reach the bone. After checking with scopy in two planes, the cannula trocar system was advanced to the middle of the vertebral body by the unilateral parapedicular route. The inflatable bone tampon prepared with radiocontrast inflation medium was inflated at the appropriate pressure within the vertebral body and maximum reduction was achieved. In the operations, an amount of cement ranging from 4 cc to 10 cc was injected at the thoracic and lumbar levels, taking into account the vertebral volume, fracture shape, and etiology.
Results: Between January 2021 and February 2022, 20 patients underwent unilateral parapedicular balloon kyphoplasty at the Neurosurgery Clinic of Dokuz Eylul University Hospital. Fifteen of the patients were female and 5 were male, the youngest was 47 years old and the oldest was 79 years old. While 14 patients had a history of trauma, 6 patients had no history of trauma. All of the patients were discharged with good health the day after the procedure. The parapedicular route is more advantageous in terms of reaching the center of the vertebral body. It is stated that with this method, more and easier cement can be injected from the edge of the pedicle to the center of the vertebral body by licking the transverse process, and a smaller diameter cannula can be used.
Conclusions: Theoretically, more cement injections provide more stabilization, so bilateral procedures should be more effective. However, it has been observed that surgery performed with a unilateral parapedicular approach by experienced surgeons provides more pain regression in the early period, has a lower complication rate due to its unilateral nature, and provides adequate stabilization when an appropriate amount of cement is injected.
Keywords: kyphoplasty, vertebral fracture, unilateral parapedicular