Safety and efficacy of balloon kyphoplasty at 4 or more levels in a single anesthetic session

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>In this case series, the authors evaluated the safety of balloon kyphoplasty at 4 or more vertebral levels in a single anesthetic session. The current standard is that no more than 3 levels should be cemented at one time because of a perceived risk of increased complications.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective chart review was performed for 19 consecutive patients who underwent ≥ 4-level balloon kyphoplasty between July 1, 2011, and December 31, 2015. Outcomes documented included kyphoplasty-associated complications and incidences of subsequent vertebral fracture.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Nineteen patients aged 22 to 95 years (mean 66.1 years, median 66 years; 53% male, 47% female) had 4 or more vertebrae cemented during the same procedure (mean 4.6 levels [62 thoracic, 29 lumbar]). No postoperative anesthetic complication, infection, extensive blood loss, symptomatic cement leakage, pneumothorax, or new-onset anemia was observed. Five patients experienced new compression fracture within a mean of 278 days postoperatively. One patient with metastatic cancer suffered bilateral pulmonary embolism 19 days after surgery, but no evidence of cement in the pulmonary vasculature was found.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this case series, kyphoplasty performed on 4 or more vertebral levels was not found to increase risk to patient safety, and it might decrease unnecessary risks associated with multiple operations. Also, morbidity associated with leaving some fractures untreated because of an unfounded fear of increased risk of complications might be decreased by treating 4 or more levels in the same anesthetic session.</jats:p></jats:sec>

A Multimodal Clinical Approach for the Treatment of Bone Metastases in Solid Tumors

“…Based on the European Society for Medical Oncology guidelines, spine surgery is indicated only in the case of malignant spinal cord compression (SCC) ( 56 ). In patients with vertebral metastases without evidence of malignant SCC, spinal instability, refractory mechanical pain to analgesics, and vertebral body collapse, non-invasive percutaneous treatments, such as vertebroplasty or Kyphoplasty, are frequently indicated ( 42 , 57 ). Vertebroplasty is a minimally invasive technique in which bone cement (polymethylmethacrylate) is injected into the vertebral body.…”

“…On the other hand, Kyphoplasty involves the placement of a balloon in the vertebral body, containing the spread of cement. Both procedures are considered safe with few side effects ( 57 ). However, if the cement leaks, depending on the location of the cement leakage, an adverse event may occur that potentially causes compression of the nerve root or disc irritation.…”

Vertebro- und Kyphoplastie

“…Empfehlung zum operativen Vorgehen in Abhängigkeit des OF-Grades und OF-Scores nach Blattert 2019[9]. Vertebra plana (Resthöhe < ⅓ der ursprünglichen Höhe) ▪ Zementallergie (PMMA) zahlen zeigten jedoch auch für die simultane Versorgung auf ≥ 4 Etagen kein erhöhtes perioperatives Risiko[15,16].…”