Fatih DUYGUN, Fırat SEYFETTİNOĞLU, Önder ERSAN, Tarık SARIŞIK, Bülent ÇELİK, Yalım ATEŞ

Osteoporotik vertebra kırıklarında balon kifoplasti uygulamasının erken dönem sonuçları

Amaç: Osteoporotik vertebra kırığı nedeniyle uygulanan balon kifoplastinin erken dönem sonuçları değerlendirildi. Çalışma planı: Çalışmaya osteoporotik vertebra kırığı nedeniyle balon kifoplasti yapılan 16 hasta (11 kadın, 5 erkek; ort. yaş 66; dağılım 55-75) alındı. Bir olguda osteoporotik kırık iki seviyede idi. Kırık oluşumu ile ameliyat arasındaki süre ortalama iki ay (dağılım 0-4 ay) idi. Balon kifoplasti için ortalama 4.5 ml (dağılım 3-6 ml) çimento kullanıldı. Tüm hastalara bipediküler balon kifoplasti uygulandı. Fonksiyonel sonuçlar Oswestry Engellilik Ölçeği (Oswestry Disability Scale-ODS) ve görsel analog skala (GAS) ile değerlendirildi. Ortalama takip süresi 18 ay (dağılım 13-27 ay) idi. Sonuçlar: Ameliyattan önce 16? olan ortalama lokal kifoz açısı son kontrolde 11.8?, 16.7? olan anterior kompresyon açısı 9.6? bulundu. Lokal kifoz açısında ve anterior kompresyon açısındaki düzelme sırasıyla %26.3 ve %42.5 idi. Cisim yüksekliğinde %44.4, ön duvar yüksekliğinde %37.9 artış elde edildi. Fonksiyonel değerlendirmede, ameliyat öncesinde 13.8 olan ODS puanı son kontrolde 6.6’ya; 4.2 olan GAS puanı ise 1.7’ye geriledi. İki ölçekte sağlanan iyileşme sırasıyla %52.2 ve 59.5 idi. Dört hastada çimento sızması (2 anteriora, 2 posteriora) gözlendi. Bunun dışında herhangi bir komplikasyonla karşılaşılmadı. Çıkarımlar: Osteoporotik vertebra kırıklarında balon kifoplasti, minör cerrahi olması, hasta memnuniyeti ve düşük komplikasyon oranı nedeniyle uygun endikasyonlarda tercih edilebilecek iyi bir yöntemdir.

Anahtar Kelimeler:

Bel ağrısı, Omurga kırıkları, Osteoporoz, Torasik omurga, Tedavi sonucu, Kırıklar, çökme, Lumbar omurga

Early results of balloon kyphoplasty for osteoporotic spinal fractures

Objectives: We evaluated early results of osteoporotic spinal fractures treated with balloon kyphoplasty. Methods: The study included 16 patients (11 females, 5 males; mean age 66 years, range 55 to 75 years) who were treated with balloon kyphoplasty for osteoporotic spinal fractures. One patient had vertebral fractures at two levels. The mean duration from trauma to kyphoplasty was two months (range 0 to 4 months). The mean amount of cement used during the procedures was 4 ml (range 3 to 6 ml). Kyphoplasty was performed with a bipedicular approach in all the patients. Functional results were assessed with the Oswestry Disability Scale (ODS) and a visual analog scale (VAS). The mean follow-up period was 18 months (range 13 to 27 months). Results: Compared to the preprocedure measurements, the mean local kyphosis angle decreased from 16° to 11.8°, and anterior compression angle decreased from 16.7° to 9.6°, the improvements being 26.3% and 42.5%, respectively. The mean vertebral body and anterior wall heights increased by 44.4% and 37.9%, respectively. At final evaluations, the ODS score decreased by 52.2% (from 13.8 to 6.6) and the VAS score decreased by 59.5% (from 4.2 to 1.7). No complications were encountered other than cement extrusion at two aspects of the vertebral body (2 anterior, 2 posterior leaks). Conclusion: Being a minor surgical procedure, balloon kyphoplasty is an appropriate treatment in osteoporotic vertebral fractures with high patient satisfaction and low complication rate.

Keywords:

Low Back Pain, Spinal Fractures, Osteoporosis, Thoracic Vertebrae, Treatment Outcome, Fractures, Compression, Lumbar Vertebrae,

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1. Eryavuz Sarıdoğan M. Osteoporoz epidemiyolojisi. In: Gökçe Kutsal Y, editör. Osteoporoz. Ankara: Güneş Kitabevi; 2001. s. 5-36.
2. Melton LJ 3rd. Epidemiology of spinal osteoporosis. Spine 1997;22(24 Suppl):2S-11S.
3. Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. [Article in French] Neurochirurgie 1987;33:166-8.
4. Caner H, Atalay B. Vertebroplasti ve kifoplasti. In: Aksoy K, editör. Temel Nöroşirurji. Ankara: Türk Nöroşirurji Derneği; 2005. s. 1026-31.
5. Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 2000;25:3115-24.
6. Alanay A. Osteoporotik kırıkların tedavisinde perkütan vertebroplasti ve kifoplasti. Totbid Dergisi 2003;2:17-26.
7. Guglielmino A, Sorbello M, Barbagallo G, Murabito P, Naimo J, Zingale SF, et al. Osteoporotic vertebral compression fracture pain (back pain): our experience with balloon kyphoplasty. Minerva Anestesiol 2007;73:77-100.
8. Kim HS, Ju CI, Kim SW, Lee SM, Shin H. Balloon kyphoplasty in severe osteoporotic compression fracture: is it a contraindication? Neurosurgery 2007;[Epub ahead ofprint].
9. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 1997;18:1897-904.
10. Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging 2002;26:1-5.
11. Choe DH, Marom EM, Ahrar K, Truong MT, Madewell JE. Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol 2004;183:1097-102.
12. McKiernan F, Faciszewski T, Jensen R. Quality of life following vertebroplasty. J Bone Joint Surg [Am] 2004;86: 2600-6.
13. Chen LH, Lai PL, Chen WJ. Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res 2005;(435):148-53.
14. Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A. New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR Am J Neuroradiol 2005;26:1601-4.
15. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M. Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J 2005;14:466-73.
16. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 2000;39:1410-4.
17. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 1999;26:2222-8.
18. Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 2001;22:373-81.
19. Steinmann J, Tingey CT, Cruz G, Dai Q. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine 2005;30:201-5.