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Osteoporotic Compression Fracture and Percutaneous Vertrebroplasty dr.sandeep c agrawal agrasen hospital gondia maharashtra india

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Percutaneous Vertebroplasty, Ballon Kyphoplasty,Osteopotic Compression Fracture,Lumabar Spine,Thoracic Spine,Cement Leak,Spine Screw Fixation,Bone Loss Trabeculae,Wedging,BMD,T score,Z Score,Vitamin D3,Calcium Deficiency,Osteomalacia,Hip Fracture Osteoporotic compression fracture and percutaneous vertrebroplasty dr.sandeep c agrawal agrasen hospital gondia maharashtra india

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Osteoporotic Compression Fracture and Percutaneous Vertrebroplasty dr.sandeep c agrawal agrasen hospital gondia maharashtra india

  1. 1. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Osteoporotic Compression Fracture And Percutaneous Vertebroplasty
 Loss of body Height Kyphotic deformity Dr.Sandeep Agrawal Consultant Orthopedic Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India www.agrasenortho.com drsandeep123@gmail.com
  2. 2. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Osteoporotic Compression Fracture 1.Most can be treated by bed rest, brace, and analgesics ! 2.Rarely surgically treated – High complications rate by implant fixation ! 3.Alternative - Minimally Invasive Method
  3. 3. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Percutaneous Vertebroplasty ●Deramond 1984 – Vertebra Hemangioma
  4. 4. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 4 Vertebral Compression Fracture Thoracic: wedge by kyphotic loading ! Lumbar: central endplate cupping ! ! MRI: high sensitivity Bone scan Sagittal reconstructed CT images
  5. 5. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 5 Imaging guided percutaneous spine intervention. ! For painful benign or malignant, pathologic vertebral fracture. Vertebroplasty
  6. 6. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 6 Confirmed by X-ray & MRI ! Pain corresponding to level of the fracture ! Unresponsive to conservative treatment Patient Selection Criteria
  7. 7. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 7 Contraindications Uncorrected coagulopathy ! Infection – local or systemic ! Moderate or severe retropulsion of posterior vertebral body cortex into spinal cord ! Vertebra plana: Height loss > 80%
  8. 8. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 8 Procedures General or local anesthesia ! Prone position (posture reduction) ! Unilateral or bilateral transpedicular approach under fluroscopic control ! Cement - barium sulfate mixture
  9. 9. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 9 Introduction
 (Percutaneous vertebroplasty ) Galibert and Deramond in 1987 ( vertebral angioma )! Lapras in 1989 ( osteoporotic compression fracture )! Decreasing the pain and improving the function ! Benefit from this procedure is uncertain
  10. 10. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 10 Procedure Route chosen ! Cement leakage ! Nonevident! Epidural plexus! Lumbar venous plexus! Adjacent disc! Epidural space ! Postprocedural complications
  11. 11. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 11 Radiologic Number of vertebral levels ! ! Percentage loss of vertebral height ! Distance (endplate to endplate) at center of vertebral body ! ! Height of vertebra above fractured vertebra =>! ! Estimation of the prefracture height ! Height lost = (fractured height/estimated prefractured height) × 100
  12. 12. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 12 Radiologic Location of the vertebral level ! T spine :T1 - T10! TL junction : T11 - L2! L spine : L3 - L5 ! Type of deformity (wedge, biconcave, or compression) and osteonecrosis
  13. 13. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 13 Height loss associated with unfavorable result! 71.4% in vertebrae with a height loss higher than 70%
  14. 14. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 14 Leakage into disc associated with worse result
  15. 15. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Imaging Guided Percutaneous Spine Intervention. ! New Treatment for Painful Benign or Malignant Vertebral Compression Fracture Percutaneous Vertebroplasty
  16. 16. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India!
  17. 17. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 17
  18. 18. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 85 year male, low back pain after trauma for one year L1 compression Fracture
  19. 19. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! T12 compression Fracture with nonunion
  20. 20. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 74 Year female, T11 T12 L1 Multiple Compression Fractures
  21. 21. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Percutaneous Vertebroplasty Minimal invasive method Stabilize the fracture vertebra Dramatic Decreased back pain => Improved life quality
  22. 22. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Pain Relief in Vertebroplasty Prevention of micromotion ! Mechanical stabilization ! Monomer cytotoxicity or exothermic reaction - Thomas A. Einhorn. Spine 
 vol 25. no. 9 -
  23. 23. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Complications of Vertebroplasty Cement leakage Adjacent new compression fracture Pulmonary embolism Infection ● Subcutaneous hematoma ● Neurological deficit
  24. 24. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Cement Leakage 34~75% Not generally lead to complications Possible paraplegia ! ! ! ! ! ! ! - OKU 7 -
  25. 25. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Pulmonary Embolism
  26. 26. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Increase Fracture Risk at 
 Adjacent Vertebrae Additional new fractures within one year - 15 % (46/300 patients)! Garfin et al, Eurospine 2001
  27. 27. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Risks for Adjacent Fracture Adjacent fracture is not associated with age, sex, fracture level, bone mineral density, cement volume and kyphotic angle. - Chen APOA 2004
  28. 28. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 28 Adjacent level fracture
  29. 29. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Adjacent Fracture 
 After Vertebroplasty Natural course of disease Provoked by an adjacent rigid reinforcement. Mechanism :
 Combination of the underlying condition , osteoporosis , neoplastic disease , hard cement in the disc , increased activities after vertebroplasty
  30. 30. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 30 Vertebroplasty : Cement Leakage into the Disc Increases the Risk of New Fracture of Adjacent Vertebral Body AJNR Am J Neuroradiology 25 , February 2004 
 Edward P.Lin, Sven Ekholm, Akio Hiwatashi, and Per-Lennart Westesson Department of Radiology, Division of Diagnostic & Interventional Neuroradiology , 
 University of Rochester Medical Center, Rochester , New York
 Mechanism :
 Combination of the underlying condition , osteoporosis , neoplastic disease , hard cement in the disc , increased activities after vertebroplasty
  31. 31. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 31 Discussion The amount of cement injected during vertebroplasty
 The amount of cement that leaked into the disc 
 
 
 
 
 The incidence of new fractures
 
 
 
 
 Require further studies
  32. 32. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 32 Discussion We should attempt to reduce the incidence and the amount of cement leakage into the disc during vertebropalsty : 
 ! The needle tip location – laterally , not centrally 
 The consistency of the cement – more viscous 
 The volume of cement injected – smaller volume 
 Stopping injection when detecting leakage into
 disc , resumed after cement slightly hardened
  33. 33. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 33 Discussion Supplementary Vertebroplasty +
 Posterior instrumentation and P-L fusion Avoid anterior procedures 
 Provide sufficient axial loading of vertebral body
 Prevent implants failure
  34. 34. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Percutaneous Vertebroplasty Efficacious (but not a risk free) in pain reduction (86%) for painful osteoporotic spine fracture Skillful techniques and careful safeguards can minimize the complications
  35. 35. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 35 Discussion Percentage of excellent results decrease in > 70% loss of vertebral height! ! Difficult technically! ! High incidence of disc leakages! ! Complete relief < 30% (29.6%) of the patients ! ! Progression of the fracture is evident => PV! ! Fracture remains stable => keep conservative treatment
  36. 36. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 36 Discussion Involvement of > 2 segments was associated with worse outcome! ! Disseminated disease and multiple level fractures are less likely to be free of pain after a PV
  37. 37. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Conclusions Appropriate patient selection is essential for achieving clinical success Back pain is correlated to image study esp. MRI
  38. 38. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! Conclusions Better results can be expected in patients with an ASA score of I and the vertebral body height loss is less than 70%.
  39. 39. Dr.Sandeep C Agrawal Agrasen Hospital Gondia India! 39 Have Fun! ! ! In our busy daily lives, most of us have! forgotten one of the bare essentials of! a happy life - having fun!! ! ! Be silly. Crack jokes. Laugh. Be mischievous.! Let your hair down. Leave your troubles! behind. Play hard. Just play.! Enjoy yourself.! ! ! We are always so busy walking and running! in our lives, we forget. We forget to stop! and dance!!

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