medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2004, Number 3

<< Back Next >>

Acta Ortop Mex 2004; 18 (3)

Transpedicular percutaneous vertebroplasty with methylmetacrilate. Pain control by means of osteopenic vertebral crushing

Hernández CB, Bravo BPA, Camarillo JFM

Language: Spanish
References: 16
Page: 82-85
PDF size: 355.58 Kb.


ABSTRACT

In 1987 in France it was described the percutaneous application of an acrylic polymer - polimethylmetacrilate (PMM)- to vertebral body defects associated to pain in fractures caused by osteoporosis and tumor-like lesions with a satisfactory result with relation to pain control up to 90% of the cases. We performed a retrospective, descriptive and longitudinal study where 14 patients were included. They were elder than 60 years old, from both sexs, with a maximum of six-month evolution of thoracic and/or lumbar pain, refractory to conservative treatment and caused by one or several fractures with a crushing coming from an osteoporotic origin, with vertebral wedging going from 15 to 75%, integrity of the posterior rampart and a retropulsion less than 20% demonstrated by simple radiographic image, verified by TAC or magnetic resonance and confirmed by vertebrography. These patients were practiced a transpedicular percutaneous vertebroplasty with PMM. The pain, assessed by EVA (with 10 as the maximum pain and 0 as no pain), ranged from 8 in the preoperative period to 1.5 in postoperative; 0 in 6 of the cases, pain 2 in 6 cases, pain 4 in one case, and pain 5 in one case, what represents the 85.7% of good and excellent results. Two complications were observed; one patient suffered from intercostal neuritis because the PMM exceeded the posterior edge of the vertebral body and got lodged in the rachidian duct; the problem decreased when the patient was practiced an epidural blocking. The second case presented cough with expectoration for three weeks and it was diagnosed pulmonary embolism due to PMM. This case had a total recovery. We consider that vertebroplasty with PMM is a good alternative for treating thoracic-lumbar pain in cases that present no response to conservative treatments due to osteopenic fracture in the old.


REFERENCES

  1. Barr JD, Barr MS, Lemley TJ, McCann RM: Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000; 25(8): 923-928.

  2. Bravo BPA: Traumatología del Musculoesquéletico en el Viejo. Introducción a la Geriatría. Mendez Editores 1992; 134-139.

  3. Cáceres PE: Fracturas vertebrales. Fracturas en el anciano. Secot 2001: 105-120.

  4. Debussche-Depriester C, Deramond H, Fardellone P, et al: Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic vertebral crush fracture syndrome. Neuroradiol 1991; 33 (suppl): 149-152.

  5. Deramond H, Depriester C, Galibert P, Le Gars D, et al: Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications and results. Radiol Clin North Am 1998; 36(3): 533-546.

  6. Deramond H, Wrigth NT, Belkoff SM: Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 1999; 25(suppl): 17-21.

  7. Galibert P, Deramond H, Depriester-Debussche C: Percutaneous Vertebroplasty with methil-methacrylate: Technique, method, and results. Radiol 1990; 117 (suppl): 352.

  8. Galibert P, Deramond H, Rosat P, Le Gars D, et al: Preliminary note on the treatment of vertebral angina by percutaneous acrylic vertebroplastic. Neurochirurgie 1987; 33(2): 166-168.

  9. Hernández B, Parada R: Metilmetacrilato como relleno en cuerpos vertebrales para mejorar la resistencia mecánica ósea. Estudio experimental en vértebras de cadáver y porcino. AOM 2003; 17(3): 134-138.

  10. Jensen ME, Kallmes DF, Short JG, et al: Percutaneous vertebroplasty does´not increase the risk of adjacent vertebral fracture-a retrospective study (abstract) proceedings of the 38th Annual Meeting of the American Society of Neuroradiology. Atlanta, Ga, Paper 1, 2000: 4-5.

  11. Jensen ME, Evans AJ, Mathis JM, et al: Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 1997; 18(10): 1897-1904.

  12. Mathis JM, et al: Percutaneous vertebroplasty. JBR-BTR 2003; 86(5): 299-301.

  13. Mathis JM, Petri M, Naff N: Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum 1998; 41(1): 171-175.

  14. Padovani B, Kasriel O, Brunner P, et al: Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999; 20:(3) 375-377.

  15. Thongtrangan I, Le H, Park J, Kim DH: Minimally Invasive Spinal Surgery: A Historical Perspective. Neurosurgery Focus 2004; 16(1):

  16. Tohmeh AG, Mathis JM, Fenton DC, et al: Biomechanical efficacy of unipedicular versus pedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 1999; 24(17):1772-1776.




2020     |     www.medigraphic.com