A Nomogram to Predict Intra-Spinal Canal Cement Leakage Among Elderly Patients with Spine Metastases: An Internal-Validated Model

Object. Percutaneous vertebro- and kyphoplasty have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures. In the setting of severe fractures involving fragmentation of the posterior wall and neural compromise, however, decompressive surgery cannot be performed and epidural cement leakage is poorly controlled. A microsurgical interlaminary approach for vertebro- and kyphoplasty was developed to allow spinal decompression and control of the spinal canal during augmentation. Methods. Interlaminary vertebro- or kyphoplasty was performed in 24 patients with osteoporotic fractures involving neural compression or posterior wall fragmentation. After unilateral microsurgical fenestration, decompression of the spine, and gentle mobilization of the thecal sac, vertebro- or kyphoplasty was performed directly through the posterior wall of the fractured vertebral body. Cement was injected under microscopic and fluoroscopic control, with the option of immediate exploration of the exposed spinal canal. Thirty-four levels (T-8 to L-5) were treated. Mean blood loss was less than 100 ml and augmentation added 10 to 40 minutes to the entire procedure. Cement leakage associated with the kyphoplasty procedure was less than that in vertebroplasty. There were no major complications. One patient was lost to follow up. Clinical outcome was good or excellent in 17 of the 23 patients available for follow-up (1 to 31—month) evaluation. Conclusions. The present microsurgical interlaminary approach for vertebro- and kyphoplasty enables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decompressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively. This technique can be regarded as a procedure on the treatment continuum between percutaneous augmentation and conventional open reconstruction.

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Surgical outcomes for lumbar spinal canal stenosis in elderly patients

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i5.441 ◽

2018 ◽

Vol 5 (5) ◽

pp. 2279-2286

Author(s):

Babak Mirzashahi ◽

Mohammad Aghajani ◽

Fatemeh Mirbazegh ◽

Jayran Zebardast ◽

Elham Ghasemi

Keyword(s):

Elderly Patients ◽

Activities Of Daily Living ◽

Surgical Outcomes ◽

Spinal Canal ◽

Daily Living ◽

Spinal Canal Stenosis ◽

Fear Avoidance ◽

Lumbar Spinal Canal Stenosis ◽

Canal Stenosis ◽

Lumbar Spinal

Purpose of the study: To understand surgical outcomes, based on standardized tools, after surgery of lumbar spinal canal stenosis in patients aged 65 years and older. Methods: A cross-sectional study was undertaken in 58 elderly patients before and after surgery. Demographic data, procedures, perioperative comorbidities, preoperative and postoperative pain intensity, primary activities of daily living, quality of life, and fear avoidance were collected at baseline. All patients were followed up to 6 and 12 months after operation. Results: Following surgery, there was a significant reduction in the VAS scale (for pain severity) and fear avoidance beliefs (FAB) questionnaire scale (P<0.001), and a significant increase in the 36-Item Short Form Health Survey (SF-36) index and the Barthel Index for Activities of Daily Living (ADL), which assesses functional independence) (P<0.001). Implication: The present study suggests that surgery in elderly patients is effective for the treatment of spinal stenosis, in those patients who did not respond well to conservative treatment.

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Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e1021 ◽

2015 ◽

Vol 6;18 (6;11) ◽

pp. E1021-E1028

Author(s):

Yan Yang

Keyword(s):

Spinal Canal ◽

Invasive Procedure ◽

Cement Leakage ◽

Spinal Canal Stenosis ◽

Stage Iii ◽

Canal Stenosis ◽

Institutional Review ◽

Kummell’S Disease ◽

Kümmell’S Disease

Background: Percutaneous kyphoplasty (PKP) has been proven as an effective, minimally invasive procedure for the treatment of Kummell’s disease in the early stages. However, a risk of cement leakage and further neurological damage remains during and after PKP, especially in chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Objective: To evaluate the feasibility and efficacy of PKP for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Study Design: A retrospective evaluation of postoperative radiographs. Setting: Pain management clinic. Methods: A retrospective study was performed on 9 patients with 11 levels managed with PKP for chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Clinical and radiological outcomes were assessed. Results: Substantial pain relief was attained in all the patients. Both visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from pre- to post-operation (P < 0.05), and remained unchanged at every follow-up. No neurological deterioration was found. Postoperatively, the anterior and midline vertebral body heights were significantly corrected (P < 0.05), and were sustained at the final follow-up. Similar results were seen in the correction of kyphotic angle. Neither cement leakage into the spinal canal nor further dislodging of the posterior vertebral fragments occurred. Two cases experienced subsequent fractures with one having a second PKP and the other being treated conservatively. Limitations: Retrospective study of 9 cases with 11 levels due partly to the rarity of the disorder. Conclusions: PKP is an effective, minimally invasive procedure for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal stenosis, leading to a significant relief of symptoms and improvement of functional status. Institutional Review: This study was approved by the Institutional Review Board. Key words: Kummell’s disease, kyphoplasty, spine, osteoporosis, cement leakage, polymethylmethacrylate, neurological deficits, burst fractures

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Dorsolumbar Vertebroplasty- A Retrospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46215.14758 ◽

2021 ◽

Author(s):

Murat Yilmaz ◽

Nihat Acar ◽

Ahmet Aybar ◽

Ahmet Karakasli

Keyword(s):

Retrospective Study ◽

Spinal Canal ◽

Posterior Longitudinal Ligament ◽

Cement Leakage ◽

Radicular Pain ◽

Decompression Surgery ◽

Inclusion Criteria ◽

Vertebral Metastasis ◽

Disc Space ◽

The Mean

Introduction: Percutaneous Vertebroplasty (PVP) is a procedure frequently performed to obtain pain relief and mechanical strengthening of the collapsed vertebral body which may be caused by variant reasons. Aim: To assess frequent complications commonly encountered during vertebroplasty procedure. Materials and Methods: A retrospective study was conducted on 1375 patients followed from January 2005 and June 2012 in Department of Neurosurgery, faculty of medicine, Dokuz Eylül University. Severe vertebral fracture collapse (vertebra plana), vertebral metastasis, quadriplegic patients and bed-ridden patients were excluded from this study, whereas active mobile patients without associated severe co-morbidities were included in the study. Pain, pattern of cement leakage and associated complications had been assessed. Results: Total 601 patients who fullfilled the inclusion criteria {244 (40.5%) males, 357 (59.5%) females}, average age was 63.04±7.4 (range 34 to 90) years, had undergone the PVP procedure. Mean preoperative Visual Analog Scale (VAS) was 8.51±1.5, whereas after one and six months, the mean postoperative VAS were 1.94±1.0 and 2.53±2.2, respectively. Central spinal canal leakage has been observed in four cases. Three patients had developed transient monoparesis and radiculopathy symptoms. Whereas, the fourth patient developed paraplegia. Cement leakage had been tolerated well by one patient, where symptomatic resolution occurred within one month. However, decompressive foraminotomy had been performed for two patients on the 24th and 38thdays postoperatively due to intractable radicular pain. Immediate total laminectomy and decompression surgery had been performed for removal of the cement leakage to the spinal canal for the patient who developed total paraplegia. Asymptomatic leakage had been recognised beneath the posterior longitudinal ligament in 42 patients (6.9%), beneath the anterior longitudinal ligament in 18 patients (2.9%) and into disc space in 31 patients (5.1%). Venous leakage occurred in four patients (0.6%) and was asymptomatic in all of them. Conclusion: Vertebroplasty should be performed in a fully equipped operation theater in order to be able to revert quickly to open surgery in case of cement leakage into the spinal canal.

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