Vertebroplasty--high viscosity cement versus low viscosity cement [Vertebroplastika - visokoviskozni cement naspram niskoviskoznog cementa]

Rapan, Saša and Jovanović, Savo and Gulan, Gordan and Boschi, Vladimir and Kolarević, Vjekoslav and Đapić, Tomislav (2010) Vertebroplasty--high viscosity cement versus low viscosity cement [Vertebroplastika - visokoviskozni cement naspram niskoviskoznog cementa]. Collegium Antropologicum, 34 (3). pp. 1063-1067. ISSN 0350-6134

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Abstract

The patients with intensive pain caused by the vertebra body fracture were treated by application of low viscosity cement (LVC), (Vertebroplastic, DePuy) and high viscosity cement (HVC), (Confidence, DePuy,) into the body, by means of diascopy through unilateral transpendicular approach. Application of LVC was made in 75 patients, on 109 vertebrae, and HVC was applied in 12 patients on 14 vertebrae. Application of LVC was performed on 48 thoracic and 61 lumbar vertebrae and 5 thoracic and 9 lumbar vertebrae were stabilized with HVC. 43 patients were treated for malignancy and in 38 for osteoporosis. For LVC, preoperative VAS score was 8.32 and 2.23 (p < 0.00001) 24 hours after surgery, and it remained stable 3 month later. For HVC, preoperative VAS score was 7.99 and it was 2.5 (p < 0.00001) 24 hours after surgery and 3 months later. In the group of patients treated with LVC, there was 1 serious complication, a paraparesis caused by the leakage of cement into the spinal canal, which was partially recovered after decompression and rehabilitation treatment and 2 superificial infections with S. epidermidis which were cured by means of antibiotics. In 32 vertebrae (32) cement leakage extra ossal, either into vein plexus or intradiscal during surgery were noticed. When HVC was applied, intradiscal leakage occurred in one case only (8%). By means od Wilcoxon paired test a significant difference was found between the preoperative VAS, and the values immediately after surgery and 3 months later (Z = 7.52, p < 0.00001) when LVC was applied., and with HVC it was ( Z = 3.04, p < 0.00001), which indicates that the fast achieved pain reduction remained stable during the 3 month follow-up. The vertebroplasty is a safe and efficient surgical method in treatment of compressive vertebrae fractures which do not react to the conventional method of treatment. This method, when HVC is applied, shows significantly less complications related to cement leakage.

Abstract in Croatian

Ispitanici s jakom boli uslijed loma trupa kralješka liječeni su aplikacijom niskoviskoznog (NVC), (Vertebroplastic, DePuy) i visokoviskoznog (VVC), (Confidence, DePuy) cementa u trup uz pomoć dijaskopije, unilateralnim transpedikularnim pristupom. Aplikacija (NVC) je učinjena u 75 pacijenata, na 109 kralježaka, a (VVC) u 12 pacijenata, na 14 kralježaka. Zahvat je uz primjenu NVC učinjen na 48 torakalnih i 61 slabinskom, a uz pomoć VVC stabilizirano je 5 torakalnih i 9 slabinskih kralježaka. 49 pacijenata liječeno je zbog malignog oboljenja, a 38 zbog osteoporoze. Prijeoperacijski VAS iznosio je prosječno 8,32 za NVC, nakon 24 sata 2,23 (p<0,00001) i ostao je nepromjenjen 3 mjeseca iza operacije. Kod liječenja VVC prijeoperacijski VAS iznosio je 7,99, da bi nakon 24 sata i 3 mjeseca nakon iznosio 2,5 (p<0,00001). U skupini liječenih NVC imali smo jedan slučaj istjecanja cementa u spinalni kanal s posljedičnom paraparezom, koja se djelomično oporavila nakon dekompresije i rehabilitacije. U dva slučaja imali smo površinsku infekciju S. Epidermidisom koja je izliječena primjenom antibiotika. U 32 kralješka (32%) evidentirali smo intraoperacijski istjecanje cementa ekstraosalno, u venski splet ili intradiskalno. Kod uporabe VVC u samo jednom slučaju (8%) došlo je istjecanja cementa intradiskalno. Wilcoxonovim testom vezanih parova utvrđena je značajna razlika između prijeoparacijskog VAS-a, te vrijednostima odmah i 3 mjeseca nakon operacije (Z=7,52, p<0,00001) kod rada NVC, a kod rada VVC (Z=3,04, p<0,00001), što upućuje na brzo smanjenje bolova nakon operacije, koje ostaje stabilno i 3 mjeseca nakon. Vertebroplastika je sigurna, djelotvorna operacijska metoda u liječenju kompresivnih lomova trupa kralješka koji ne reagiraju na konzervativan način liječenja. Ova metoda uz primjenu VVC ima znatno manje komplikacija vezanih za istjecanje cementa.

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