gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Consequences of intraspinal methylacrylate (Palacos) as a complication of vertebroplastic procedures in osteoporotic vertebral fractures of the elderly

Konsequenzen eines intraspinalen Austritts von Metylacrylat (Palacos) als Komplikation der Vertebroplastie in osteoporotischen Wirbelkörperfrakturen älterer Patienten

Meeting Abstract

  • H. Lopez - Neurochirurgische Klinik, HELIOS Klinikum Berlin, Klinikum Buch, Berlin
  • corresponding author Kajetan von Eckardstein - Neurochirurgische Klinik, HELIOS Klinikum Berlin, Klinikum Buch, Berlin
  • C. Baumann - Neurochirurgische Klinik, HELIOS Klinikum Berlin, Klinikum Buch, Berlin
  • J. Kiwit - Neurochirurgische Klinik, HELIOS Klinikum Berlin, Klinikum Buch, Berlin

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 12.131

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0415.shtml

Veröffentlicht: 23. April 2004

© 2004 Lopez et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Vertebroplasty has gained considerable importance in the treatment of symptomatic osteoporotic and metastatic spinal fractures. Since vertebroplasty can be undertaken under local anaesthesia, it is a useful option especially in the geriatric population that is at high risk for general anaesthesia.

Methods

We retrospectively evaluated consecutive cases of transcutaneous verteboplastic procedures in osteoporotic spinal fractures of the elderly (under 60 years) in a 21 month period and reviewed pre- and postoperative CT scans. The incidence and amount of intraspinal leakage of methylacrylate was correlated to clinical outcome and evaluated concerning clinical significance.

Results

We identified 30 consecutive cases of transcutaneous vertebroplastic procedures in 26 patients of whom under 60 years of age, two of whom were under 80 years. Indications for surgery was thoracic and lumbar pain without radiculopathy. All interventions (13 thoracic, 17 lumbar) were performed under local anaesthesia to monitor motor function. Intraspinal epidural leakage occurred in 5 cases (16.6%), of which 2 cases (6.7%) showed clinical symptoms (parapareses and radiculopathy), the remaining patients were asymptomatic. Other complications included a CSF-fistula in one case and a leakage into the V. cava. In cases with intraspinal leakage, the mean amount of methylacrylate was 3.2 ml. Re-operation was necessary in the two symptomatic patients (laminectomy and removal of methylacrylate), after which they fully recovered.

Conclusions

Epidural methylacrylate leakage was observed in 16.6% of cases of transcutaneous vertebroplastic procedures in the elderly and was symptomatic in 6.6%. There was no clear correlation with age and the preoperative CT scan in terms of bone density and the integrity of the dorsal wall of the vertebral body. In cases without epidural filling, vertebroplasty resulted in a significant reduction of pre-interventional pain in 24 cases (80%). Vertebroplasty is a safe and relevant procedure for the management of osteoporotic vertebral fractures in the elderly.