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The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Patients with painful thoracic fractures may be treated with short-term bed rest, analgesics and a spinal orthosis. If the back is still painful 6 weeks after the injury, patients may be considered for vertebroplasty or kyphoplasty. Vertebroplasty involves the injection of polymethylmethacrylate bone cement (PMMA) under pressure into the vertebral body with fluoroscopic guidance. The goals of the procedure are to stabilise the spine and decrease the pain associated with compression fractures. Kyphoplasty, on the other hand, involves inserting bilateral bone tamps with balloons into the vertebral body. These are inflated under fluoroscopic control with the bone tamp re-expanding the body, and elevating the end plates to reduce the fracture deformity. The balloons are then deflated and removed, and PMMA is placed in the cavity created by the balloons. The goals of kyphoplasty are spinal stabilisation, pain relief and restoration of vertebral body height. Significant complications have been reported, including nerve root injury and spinal cord injury resulting from cement extravasation, along with cement embolism, infection and hypotension.
Osteoporosis and Exercise in the Older Adult
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Roger P. Rossi, Talya K. Fleming, Krishna J. Urs, Sara J. Cuccurullo
Although similar, kyphoplasty is different in that a balloon catheter is passed through the cannula. Once in position, the balloon catheter is inflated to increase the collapsed space, create a defined cavity, and restore height to the collapsed vertebra. After removing the balloon, the space created is filled with cement, of which the most commonly used is polymethylmethacrylate (83). Pain relief (as measured by the visual analog scale) and functional outcome improve significantly up to 2 years, even if kyphoplasty is performed 1 month after the diagnoses, when conservative treatment failed (83). Restoration of the vertebral body height is achieved in 47% of cases, higher than in vertebroplasty procedures. At postoperative time, restoration is up to 15.4%, remaining stable up to 3 years follow-up. The control of the vertebral body height reduces the risk of secondary spine deformity in kyphosis (83). Patients operated by kyphoplasty can return to daily activities faster than conservatively treated patients, with a difference of 60 days (83). Cement leakage is less frequent after kyphoplasty procedure (83).
Thoracolumbar and sacral fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
S. Rajasekaran, Rishi Mugesh Kanna, Ajoy Prasad Shetty, Anupama Mahesh
In 20–30% of patients, the fracture may not heal completely, resulting in painful pseudarthrosis. Such patients who continue to have severe pain and who do not respond to conservative treatment may be candidates for percutaneous vertebral augmentation procedures such as vertebroplasty and kyphoplasty. Percutaneous vertebroplasty involves injecting acrylic cement into the collapsed vertebra to stabilize and strengthen the fractured vertebral body. This procedure does not restore the shape or height of the compressed vertebra. Kyphoplasty involves an initial insertion of an inflatable balloon through the pedicle into the vertebral body to re-expand the collapsed vertebra. With these procedures, pain relief has been reported in 60–100% of cases.23,24 The procedures can be performed under local or regional anaesthesia as a day case procedure.
Pain management in multiple myeloma
Published in Expert Review of Quality of Life in Cancer Care, 2018
Specialized spinal services include kyphoplasty and vertebroplasty, and represent options for controlling pain associated with vertebral collapse. They both consist in vertebral body augmentation techniques through percutaneous injection of bone cement to the vertebral bodies. In vertebroplasty, several vertebral bodies are simultaneously and directly injected with polymethacrylate bone cement or equivalent biomaterial, while in kyphoplasty a small balloon is percutaneously inserted into the vertebral body, inflated to produce a potential space, then removed to finally fill the cavity with cement. Advantages of kyphoplasty are the minor risk of cement scattering and the possibility of vertebral height restoring, while the main disadvantage is that it is more time consuming compared to vertebroplasty [76,82].
Quantification and influencing factors of perioperative hidden blood loss in patients undergoing laparoscopic ovarian cystectomy for benign ovarian tumours
Published in Journal of Obstetrics and Gynaecology, 2022
Junhan Zhou, Miaomiao Ye, Wenxiao Jiang, Xueqiong Zhu
Cao et al. (2018) proved that the longer operative time was closely related to a greater amount of HBL in percutaneous kyphoplasty. Ju and Hart (2016) demonstrated that the extension of surgical time led to increased HBL in anterior lumbar interbody fusion. These results were in agreement with the finding of our study, which showed that as the length of surgical time increased, the overall amount of HBL became higher. We thus speculated that with the extension of operation time, more blood infiltrated into the tissue and sequestered into the third space including the peritoneal cavity and intestinal space, leading to the decrease of VBL and increase of the amount of HBL.
Surgical management of spinal metastases
Published in Expert Review of Anticancer Therapy, 2018
Michael Galgano, Jared Fridley, Adetokunbo Oyelese, Albert Telfian, Thomas Kosztowski, David Choi, Ziya L. Gokaslan
Cement augmentation for treatment of pathologic vertebral body fractures is a potentially effective treatment option in select patients [31–33]. Certain metastatic tumors, such as multiple myeloma, are notorious for causing vertebral body collapse and subsequent severe pain. Significant pain relief has been shown to occur after cement augmentation [32]. The two main types of cement augmentation are kyphoplasty and vertebroplasty. Kyphoplasty entails obtaining transpedicular access to the cancellous portion of the vertebral body, and inflating a balloon to create a cavity through which cement will be injected. Vertebroplasty is similar, except that the cement is injected directly into the vertebral body, allowing it to interdigitate within the cancellous bone. Cement augmentation can also be utilized during open approaches to the spine to obtain greater screw pullout strength during transpedicular instrumentation. It should be noted that for the patient to be a candidate for vertebral body cement augmentation, it is essential that the posterior wall of the vertebral body is intact. Cement has the capacity to extravasate into the ventral epidural space if the posterior vertebral body wall is deficient in structural integrity from tumor infiltration or pathologic fracture. This can subsequently lead to neurological compromise if it is not noticed intra-operatively. We advocate the use of an intra-operative CT scan during such cases, to ensure not only that the hardware is in optimal position, but that no cement has leaked into the spinal canal. Significant amounts of consolidated epidural cement may need to be drilled out to decompress any at-risk neural structures. Although cement augmentation has classically been used for osteolytic metastatic vertebral body collapse, it has shown reduction in back pain for painful osteoblastic lesions as well [34].