kyphoplasty2
TRANSCRIPT
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KYPHOPLASTY
B. Hamze, Hassanin. Negila, JD. Laredo
Lariboisière Hospital
Paris, France
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KYPHOPLASTY / VERTEBROPLASTY
• Objectifs : Vertebroplasty: - Analgisic.
- Stabiliser.
Kyphoplasty: - Correction of vertebral body deformity
- Prevention of secondry cyphosis
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KYPHOPLASTY / VERTEBROPLASTY
• Indications: Debilitating benign or malignant bone diseases
-agressive angiomas,
-bone metastasis ,
- myeloma,
- Recent osteoporotic fractures, symptomatic, refractory to analgesics treatment
Agressive Angioma
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OSTEOPOROTIC FRACTURES
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KYPHOPLASTY / VERTEBROPLASTY
• PROCEDURE OF THE VERTEBROPLASTY
Widely described in the litterature
-General anesthesai.
-Patient in supine position.
-uni ou bi-pedicular acces
P. Galibert, H. Deramond Neurochirurgie 1987
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KYPHOPLASTY
• The kyphoplasty may be considered as a moderne vertebroplasty.
• It consists of injection of polymethylmetacrylate intra vertebral under
flouroscopy, after ballonn dilatation to get recovary of the vertebral
body height .
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KYPHOPLASTY
PROCEDURE OF KYPHOPLASTY:
Local Anesthesia:
-Preferable to the patient
-Reduce patient movement
-Compromis in case of sever Heart disease
General Anesthesia:
- Preferable Method
-More confortable
-Strict supine position
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• Procedure:
- bi-pediculaire acces
- a 11 Gauge needle should
Be always inside the pedicular
eye
- according to an oblique course of
the anteromedial and top to bottom
KYPHOPLASTY
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KYPHOPLASTY
• PROCEDURE OF THE KYPHOPLASTY:
-A needle is placed in the vertebral body
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KYPHOPLASTY
- The hole made by a needle under Flouroscopic control
Cannulated mill
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KYPHOPLASTY
• PROCEDURE OF THE KYPHOPLASTY:
- The balloons are introduced into the tunnels
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KYPHOPLASTY
- balloons inflated simultaneously
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KYPHOPLASTY
• PROCEDURE OF THE KYPHOPLASTY:
- The balloons are deflated
then the cement is injected under
flouroscopy control in the new
cavities formed by the balloon.
- The filling is observed
under fluoroscopy
to and fro
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KYPHOPLASTY
Patient: 79 YO Female Diagnosis: Primary osteoporosis
Fracture :
T-11, 7 weeks old
Courtesy of James Hamada, M.D., Torrance, CA
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KYPHOPLASTY
Patient: 55 YO Male Diagnosis: Secondary Osteoporotic Fracture :
Courtesy of Ulrich Berlemann, M.D., Germany
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KYPHOPLASTY / VERTEBROPLASTY
• COMPLICATIONS:
- Fever, inflammatory syndrom
NSAID
- Pain recurence due local heat
- Compression:
spinal cord / nerve root
(foramen)
- Veinous Thrombosis :
ciment very liquid
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KYPHOPLASTY / VERTEBROPLASTY
• COMPLICATIONS :
- post vertebroplasty CT shows a leakage of
the ciment in about more than 70 % of cases
- 5 to 7,5 % of these cases are symptomatic,
usually well tolerated.
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KYPHOPLASTIE
• COMPLICATIONS of KYPHOPLASTY:
• The leakage of the ciment in the kyphoplasty
is about 9 %. No symptomatic complication
Has been reported.
• This low rate is due to:
- The best control of filling of the cavity made
by the ballon.
-using of an ciment less fluid
- and low injection pression.
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KYPHOPLASTY VERSUS VERTEBROPLASTY
CONCLUSION:
- The vertebroplasty constits a remarkable progression in the
manegment of malignent or symptomatic osteoporotic vertebral
fractures .
- The kyphoplasty shows low complications rate other than the
vertebroplasty in case of osteolytic lesions with cortical
destruction.
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KYPHOPLASTY VERSUS VERTEBROPLASTY
CONCLUSION:
- The anagesic and fonctional effects is similar in the two techniques.
- Actuelly, there is comparesion study of these tow procedures.
- The resultats of the kyphoplasty is more discutable , in our
experience, the restoration of the vertebral body height was
observed in 2 cases of 66.