Artikel
Consequences of intraspinal methylacrylate (Palacos) as a complication of vertebroplastic procedures in osteoporotic vertebral fractures of the elderly
Konsequenzen eines intraspinalen Austritts von Metylacrylat (Palacos) als Komplikation der Vertebroplastie in osteoporotischen Wirbelkörperfrakturen älterer Patienten
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Vertebroplasty has gained considerable importance in the treatment of symptomatic osteoporotic and metastatic spinal fractures. Since vertebroplasty can be undertaken under local anaesthesia, it is a useful option especially in the geriatric population that is at high risk for general anaesthesia.
Methods
We retrospectively evaluated consecutive cases of transcutaneous verteboplastic procedures in osteoporotic spinal fractures of the elderly (under 60 years) in a 21 month period and reviewed pre- and postoperative CT scans. The incidence and amount of intraspinal leakage of methylacrylate was correlated to clinical outcome and evaluated concerning clinical significance.
Results
We identified 30 consecutive cases of transcutaneous vertebroplastic procedures in 26 patients of whom under 60 years of age, two of whom were under 80 years. Indications for surgery was thoracic and lumbar pain without radiculopathy. All interventions (13 thoracic, 17 lumbar) were performed under local anaesthesia to monitor motor function. Intraspinal epidural leakage occurred in 5 cases (16.6%), of which 2 cases (6.7%) showed clinical symptoms (parapareses and radiculopathy), the remaining patients were asymptomatic. Other complications included a CSF-fistula in one case and a leakage into the V. cava. In cases with intraspinal leakage, the mean amount of methylacrylate was 3.2 ml. Re-operation was necessary in the two symptomatic patients (laminectomy and removal of methylacrylate), after which they fully recovered.
Conclusions
Epidural methylacrylate leakage was observed in 16.6% of cases of transcutaneous vertebroplastic procedures in the elderly and was symptomatic in 6.6%. There was no clear correlation with age and the preoperative CT scan in terms of bone density and the integrity of the dorsal wall of the vertebral body. In cases without epidural filling, vertebroplasty resulted in a significant reduction of pre-interventional pain in 24 cases (80%). Vertebroplasty is a safe and relevant procedure for the management of osteoporotic vertebral fractures in the elderly.