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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Kyphoplasty for minimally invasive surgical treatment of traumatic vertebral body fractures with interrumption ot the posterior somatic wall – 4 years of experience

Meeting Abstract

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  • corresponding author E. Pierangeli - Operative Unit of Neurosurgery “SS. Annunziata” Hospital, Taranto, Italy
  • N. Gigante - Operative Unit of Neurosurgery “SS. Annunziata” Hospital, Taranto, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.07.09

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc251.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Pierangeli 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: Kyphoplasty is a minimally invasive technique performed in patients with ospeoporotic, neoplastic and traumatic vertebral body fractures. The placement of inflatable balloons inside the vertebral body allows the restoration of the vertebral body by means of the creation of a cavity filled by acrylic resin, usually polymethilmethacrylate (PMMA). The integrity of the posterior somatic wall is the condition required to avoid the comparison of neurological disturbances due to intracanal dislocation of PMMA and bone fragments during kyphoplasty.

The aim of the study is to evaluate the effectiveness and the safety of kyphoplasty in the surgical management of traumatic vertebral body fractures with interruption of the posterior somatic wall.

Methods: In the period from Oct 2002 - June 2007, 50 kyphoplasties have been performed in 39 patients, 25 males and 14 females, with traumatic vertebral body fractures with breakage of the posterior somatic wall. The cases noted were as follows: 1 D7, 1 D8, 1 D10, 3 D11, 13 D12, 20 L1, 5 L2, 3 L3, 3 L4. 12 patients (13 vertebras) reported burst fractures with posterior dislocation of bone fragments into the spine canal. In 25 patients we performed kyphoplasty alone. In other patients, depending on the particular surgical needs, kyphoplasty was combined with: unilateral laminectomy (4 patients), bilateral laminectomy (4 patients) and posterior stabilization (2 patients).

In two patients with burst fracture we have chosen vertebroplasty, one of which was performed by way of a unilateral approach due to the fracture of a pedicle. In patients over 45 years of age, we have utilized polymethylmethacrylate (PMMA) to perform kyphoplasty while Calcibon and Kyphos were preferred in young people. Despite PMMA these two materials are based on tricalcium phosfate and are resorbable and substitute by newly formed autologous bone after several months.

Results: No neurological worsening has been noted. No patient has required other or a different surgical treatment. Subsidence has been reported in few cases of kyphoplasty performed with Calcibon.

The average age was 51,64. It was lower in males (47,64) due to more frequent car crashes and accidents at work while in females the average age (58,78) has to be connected to the higher incidence of osteoporosis.

Conclusions: The fast reduction/disappearence of pain, the satisfactory vertebral body restoration, the reduced surgical invasiveness and the reduced aesthetic damages are the characteristics that have made the success of kyphoplasty possible for the treatment of osteoporotic and traumatic vertebral body fractures with entire posterior somatic wall damage.

More than satisfactory results were seen at the periodic follow-up in patients analyzed in this study. This has allowed us to consider Kyphoplasty, either alone or in conunction with decompressive laminectomy in cases of posterior dislocation of bone fragments, a surgical option utilizable also for the minimally invasive treatment of traumatic vertebral body burst fractures and fractures with interruption of the posterior somatic wall as an alternative to traditional stabilization systems.