Kyphoplasty in the early oncologic diagnosis and treatment of vertebral fractures: a clinical study

Abstract

AIM: To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis. MATERIAL and METHODS: Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients. RESULTS: One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18-90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others' presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days. CONCLUSION: Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.

Clinical Comparison of Low and High Injection Volumes of High-viscosity Bone Cement Used in Percutaneous Vertebroplasty

“…In a recently published study involving 130 patients, who underwent percutaneous vertebral augmentation, all patients received 2-to 6-mL cement injections per vertebra during the procedure, and PMMA leakage to the vena cava was found in two cases and to the intervertebral disc was found in eight patients [10]. In another recent study comparing high-viscosity bone cement and low-viscosity bone cement, in which PVP was performed in a total of 80 patients with single-level OVCF, no statistically significant difference was observed in terms of VAS and ODI scores whereas high-viscosity bone cement was reported to cause less PMMA leakage [11].…”

Perkütan vertebroplasti uygulanan postmenopozal hastalarda osteoporoza eşlik eden sistemik hastalıklar

“…Literatürde VKK'ın tedavisinde özellikle vertebroplasti ve kifoplasti gibi perkütan teknikler ön plana çıkmıştır. Bu konuda birçok makale yayınlanmıştır (4,7) . Ancak PMMA ile vertebra korpusu güçlendirme ameliyatları uygulanmış hastalarda eşlik eden ve osteoporoza katkıda bulunan sistemik hastalıklar hakkında makale sayısı sınırlıdır.…”