Rofo 2013; 185(8): 733-740
DOI: 10.1055/s-0033-1335582
Interventionelle Radiologie
© Georg Thieme Verlag KG Stuttgart · New York

First Experience Using Navigation-Guided Radiofrequency Kyphoplasty for Sacroplasty in Sacral Insufficiency Fractures

Erste Ergebnisse der navigationsgestützten Radiofrequenz-Kyphoplastie für die Sakroplastie bei sakralen Insuffizienzfrakturen
J.-H. Klingler
,
P. Kluge
,
R. Sircar
,
E. Kogias
,
C. Scholz
,
M. T. Krüger
,
C. Scheiwe
,
U. Hubbe
Further Information

Publication History

31 December 2012

21 April 2013

Publication Date:
25 June 2013 (online)

Abstract

Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures.

Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum.

Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 ± 0.5 to 2.3 ± 1.0 (p < 0.001) on the first postoperative day and to 1.3 ± 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted.

Conclusion: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization.

Zusammenfassung

Ziel: Bewertung der Wirksamkeit und Sicherheit der Sakroplastie mittels navigationsgestützter Radiofrequenz-Kyphoplastie für sakrale Insuffizienzfrakturen.

Methoden: Die monozentrische retrospektive Beobachtungsstudie umfasst vier konsekutive Patienten mit sakralen Insuffizienzfrakturen, welche zwischen April 2010 und Mai 2012 mittels Sakroplastie unter Verwendung der navigationsgestützten Radiofrequenz-Kyphoplastie behandelt wurden. Erfasst wurden die Symptomatik, Schmerzdauer sowie -intensität und Zementextravasationen in triplanar rekonstruierten CT-Scans des Os sacrum.

Ergebnisse: Alle Patienten berichteten eine deutliche Schmerzreduktion von präoperativ VAS 8,3 ± 0,5 auf 2,3 ± 1,0 (p < 0,001) am ersten postoperativen Tag bzw. auf 1,3 ± 1,9 (p < 0,004) zum Zeitpunkt der Nachuntersuchung (durchschnittlich 20,1 Wochen). Leichtgradige Zementextravasationen traten auf, jedoch ohne Anhalt für eine Schmerzverursachung. Ferner traten keine Komplikationen oder interventionsbezogene Morbiditäten auf.

Schlussfolgerungen: Von der limitierten Erfahrung von vier Patienten scheint die navigationsgestützte Radiofrequenz-Kyphoplastie eine sichere und wirksame Behandlungsoption für sakrale Insuffizienzfrakturen darzustellen, wenngleich asymptomatische Zementextravasationen auftraten. Die auf intraoperative Bildgebung basierende 3D-Navigation vereinfacht die Positionierung der navigierten Zugangsnadeln über den long-axis Zugang. Die Radiofrequenz-Kyphoplastie bietet die Möglichkeit, eine ausreichende Menge Knochenzement mit konstanter Viskosität über die Zeit des gesamten Eingriffes und somit mit hoher Sicherheit und geringen Zementextravasationen einzubringen. Die Sakroplastie ermöglicht durch die rasche und dauerhafte Schmerzlinderung eine schnelle Mobilisierung der Patienten.

 
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