Abstract:
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Purpose: Percutaneous kyphoplasty is an emerging interventional technique in which surgical polymethylmethacrylate (PMMA) in injected into a vertebral body under imaging guidance. This technique provides increased strength and pain relief in vertebrae weakened by a variety of bone diseases.
Methods and Materials: Technique: Kyphoplasty was always performed with the patient in the prone position after induction of general anesthesia; biplane fluoroscopic guidance was used in all cases. Bilateral access to the VB was uniformly obtained. Thirteen-gauge needles were advanced through the pedicles as for verte-broplasty. A handmounted drill was used to create bilateral channels within the anterior aspect of the VB for placement of the Inflatable Bone Tamp (IBTs). The IBT is a high-pressure balloon designed to reduce the VB back to its original height by creating a cavity that is subsequently filled with the PMMA. The IBTs are available in lengths of 15 and 20 mm (maximum volume of 4 and 6 ml, respectively). Balloon inflation was performed under strict lateral fluo-roscopic control, and the inflation pressure was monitored. Bone cement cannulas were filled with the PMMA preparation. The IBTs were deflated and exchanged for the cement cannulas. A stylet, which acts as a plunger, displaces the cement into the VB. Assessments of restored VB height were performed on lateral radiographs measured before and after kyphoplasty. Calculations included the following: height regained = post-treatment height - pre-treatment fractured height; height lost = estimated prefracture height - pretreatment fractured height; percentage of restored lost height = (height regained/height lost) x 100. Local kyphosis was assessed on the lateral radiographs by measuring the angle obtained by a line parallel to the inferior endplate of the fractured vertebra and that of the vertebra one level above.
Results: Indications: Percutaneous kyphoplasty provide pain relief and bone strengthening in painful vertebral body (VB) compression fractures in the thoracic and lumbar vertebrae. Causes of compression fractures are osteoporosis, mieloma, metastasis and aggressive vertebral haemangioma. Controindications: Absolute controindications to percutaneous kyphoplasty are bleeding disorder, unstable fracture due to posterior wall involvement.
Conclusion: Conclusion Kyphoplasty represent a safe procedure and an important additions to the therapeutic choice. Precise indications for this techniques are evolving.
Masala MD, S,
Percutaneus Kyphoplasty: Indication, Contraindication, and Technique. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3108929.html
