RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0038-1637029
Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral
CT-guided Vertebroplasty for Painful Vertebral FracturesPublikationsverlauf
07. Juli 2017
23. Dezember 2017
Publikationsdatum:
23. März 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00039252/201801/lookinside/thumbnails/10-1055-s-0038-1637029_1728121712-1.jpg)
Resumen
Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada.
Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga.
Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0 a 7 donde el 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes.
Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.
Abstract
Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography.
Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS).
Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space.
Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.
Responsabilidades éticas
Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.
Confidencialidad de los datos. Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicación de datos de pacientes.
Derecho a la privacidad y consentimiento informado. Los autores declaran que en este artículo no aparecen datos de pacientes.
-
Bibliografía
- 1 Galibert P, Deramond H, Rosat P, Le Gars D. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 1987; 33 (02) 166-168
- 2 Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 2002; 223 (01) 121-126
- 3 Barragán-Campos HM, Vallée J-N, Lo D. , et al. Percutaneous vertebroplasty for spinal metastases: complications. Radiology 2006; 238 (01) 354-362
- 4 Calmels V, Vallée J-N, Rose M, Chiras J. Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2007; 28 (03) 570-574
- 5 Cotten A, Dewatre F, Cortet B. , et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996; 200 (02) 525-530
- 6 Mont'Alverne F, Vallée JN, Cormier E. , et al. Percutaneous vertebroplasty for metastatic involvement of the axis. AJNR Am J Neuroradiol 2005; 26 (07) 1641-1645
- 7 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 (10) 1897-1904
- 8 Saliou G, Kocheida M, Lehmann P. , et al. Percutaneous vertebroplasty for pain management in malignant fractures of the spine with epidural involvement. Radiology 2010; 254 (03) 882-890
- 9 Debussche-Depriester C, Deramond H, Fardellone P. , et al. Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic vertebral crush fracture syndrome. En: Proceedings of the XIV Symposium Neuroradiologicum.Berlín: Springer; 1991:149–152
- 10 Pitton MB, Herber S, Koch U, Oberholzer K, Drees P, Düber C. CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures. Eur Radiol 2008; 18 (11) 2568-2578
- 11 Tan Z, Di Z, Mao X, Zhang J, Zou R, Wang Q. Percutaneous vertebroplasty guided by preoperative computed tomography measurements. Indian J Orthop 2016; 50 (06) 622-628
- 12 Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M. Cement leakage during vertebroplasty: an underestimated problem?. Eur Spine J 2005; 14 (05) 466-473
- 13 Kallmes DF, Comstock BA, Heagerty PJ. , et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009; 361 (06) 569-579
- 14 Buchbinder R, Osborne RH, Ebeling PR. , et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009; 361 (06) 557-568
- 15 Voormolen MHJ, Mali WPTM, Lohle PNM. , et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 2007; 28 (03) 555-560
- 16 Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty. Medicine (Baltimore) [Internet]. Junio 2016;95(24). Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998452/ . (accedido Junio 2017)
- 17 Layton KF, Thielen KR, Koch CA. , et al. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 2007; 28 (04) 683-689
- 18 Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 2006; 31 (22) 2562-2568
- 19 Krueger A, Bliemel C, Zettl R, Ruchholtz S. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J 2009; 18 (09) 1257-1265
- 20 Tsoumakidou G, Too CW, Koch G. , et al. CIRSE Guidelines on Percutaneous Vertebral Augmentation. Cardiovasc Intervent Radiol 2017; 40 (03) 331-342