Percutaneous vertebroplasty

Percutaneous vertebroplasty (PV) is a so-called minimally invasive medical procedure used to treat vertebral compression fractures. 1984 vertebroplasty was first described for the treatment of fracture risk hemangiomas of the spine in France. The authors Galibert and Deramond published her article in 1987. Since then, the procedure established for the treatment of osteoporotic increasingly fractures of the spine. She is the pioneer of kyphoplasty.

Applications

They can be applied to ongoing, from a collapsed vertebral outgoing and conservative ( drug ) therapy is not sufficiently treatable pain. Initially only for stabilization of osteoporotic vertebral fractures ( Sinterungsbruch ) thought that the PV is increasingly also eg metastases in vertebrae application.

Procedure

The patient is (alternatively: CT table ) in the prone position on a fluoroscopy place and usually treated under general anesthesia. Under local anesthesia a large hollow needle is inserted through the pedicles of the affected vertebra. Then sprayed bone cement into the vertebral body one which cures under heat development in a short time.

Complications

In two thirds of cases, during the injection to a usually asymptomatic leakage of bone cement from the treated vertebral body in veins (in individual cases spread of material, in extreme cases up in the pulmonary circulation with the image of an embolism ) in the paravertebral space, in the adjacent intervertebral disc spaces or into the spinal canal. The latter can in surgery of the cervical or thoracic spine cause a spinal cord injury by compression of the spinal cord. Newer systems, such as the Confidence system, this attempt to minimize by increased cement strength. The influence of the cement on the stability of the adjacent vertebrae is currently controversial. Some studies report an increased fracture rate in the immediately adjacent to a stabilized segment vertebrae, which is attributed to changes in static conditions ( stiffening within an otherwise softened spine). An association is also likely between cement leakage into the intervertebral disc space and fractures of the downstream eddy.

Results

A very large proportion of treated patients is symptom-free after a short time or a better deal at least with medication. The good success rate of PV contrast with the comparatively low rate of serious complications. However interpret recent blinded studies indicate that the PV of a placebo treatment is not superior.

Today, the trend is clearly back to more interaction between bone cement and cancellous bone, which is typically ascribe to vertebroplasty, as well as a possible and necessary correction ( repositioning ) of the sintered vortex, which is typically ascribe to kyphoplasty.

Other methods

Kyphoplasty

Kyphoplasty is a development of vertebroplasty by the American orthopedic surgeons Mark Railey. Here, a balloon is inserted into the vertebral body, and thus back to the erect this restored to its original profile as far as possible before the cement is introduced into the cavity thus created. Since working with low pressures, it is less common to leak from the cement into the neighboring tissue. A small, passive position improvement of vertebral fracture can also be achieved with vertebroplasty.

Since 2009, there is next to this balloon kyphoplasty and radiofrequency kyphoplasty, in which a visköserer cement is used, which is then cured by radiofrequency energy. This is an outlet of the cement can be prevented.

Currently, there is a scientific debate about whether balloon kyphoplasty vertebroplasty is generally preferable, or whether kyphoplasty is more promising for specific vertebral fractures.

Spongioplastie

The Spongioplastie is located in the approach between vertebroplasty and kyphoplasty: There are two hollow needles inserted (right and left) side into the vertebral body and somewhat withdrawn after creating a respective cylindrical cavity. Then flüssigspongiöse mass is pressed.

Vesselplasty

The Vesselplasty is a process which produces similar kyphoplasty a cavity in the collapsed vertebra. Prior to introducing the liquid bone cement, however, a balloon- like network will be introduced, which will remain as additional foreign matter in the fluid and in the cooking of the cement is injected. This should also be reduced from the vortex into the surrounding tissue, the undesired leakage of bone cement.

Sakroplastie

As with vertebroplasty, bone cement is injected percutaneously into the sacrum ( sacrum ), resulting particularly in osteoporotic fractures sacrum, the sacral called insufficiency breaks good results.

Swell

• Radiology
• Invasive therapeutic procedures
• Therapeutic procedures in orthopedics and trauma surgery