经皮椎体成形术的技术方面的问题课件

Technical Aspects of Percutaneous Vertebroplasty,Dr. Cosme Argerich Neurosurgeon,History,1987: First description by Galibert and Deramond. 1995: First procedure in Geneva (Switzerland). 1997 First reported procedure in USA.,Schools,European 38% methastases 31% Hemangiomas / Myelomas 31% Osteoporosis,North American 70% Osteoporosis 17% Hemangiomas / Myelomas 13% Methastases,Demography USA,10 Million cases of Osteoporosis (45% white female 50 years). 700 thousand vertebral fractures / year. 150 thousand hospital admissions / year. Total direct costs: U$ 13.800 Millions. Estimated costs in 2030: 60.000 Millions.,Diagnostic Sequence,Indications for PV,Pain / instability in: Osteoporotic collapse. Sub-acute traumatic collapse. Malignant vertebral tumors (Metastasis / Myeloma) Vertebral angiomas,Osteoporosis,Intense and persistent post fractural pain: 1 to 12 weeks evolution. Pain focused on spinal mid-line, related to diagnosed vertebral collapse. Absence / poor response to medical therapy (Alendronate, Calcium, Opiates). Quality of Life impairment due to opiates side effects.,Osteoporosis,T1: signal reduction in D 12.,STIR: increased signal suggesting recent fracture.,Tumors,High risk of vertebral collapse. Intractable pain. Marked side effects to opiates: blurred vision, bladder / bowel disorders, confinement to bed rest. Palliative treatment in terminal patients.,Malignant Tumors,T1: signal reduction in vertebral body and posterior elements,+ C: increased signal,Note that:,Most of skeletal metastasis occur in spine. Up to 10% of cancer patients present symptomatic spine metastasis. Course of local disease may be painful and invalidating.,General Exclusion Criteria,Local / systemic infection. Recent fracture of posterior vertebral wall. Coagulation disorders. Poor general conditions. Vertebral collapse 80 90%.,Particular Exclusion Criteria,Osteoporosis. Adequate response to medical treatment. Lack of radiological progression of fracture.,Cancer: Advanced systemic disease. Progression to spinal channel.,Vertebral Approaches (will vary according to surgeons specialty and experience),Cervical Spine: Anterior. Dorsal Spine: Transpedicular. Lumbar Spine: Transpedicular. Lateral.,Alternative Approaches,Latero-transpedicular. Latero-antepedicular. Laterovertebral.,Equipment,Fixed “C” Arm,Advantages: Better image quality Easier operation,Disadvantages: High operational costs Use subject to availability,Mobile “C” Arm,Advantages: Low operational costs Availability,Disadvantages: Lesser image quality More difficult operation,Immediate access to: CT Scan and / or RMI. ICU. Operating Room. Must be available for the treatment of potential complications,Anestesia,Election will depend on surgeons experience and characteristics of patient.,Intraoperative Monitoring,EKG. O2 Saturation (early diagnosis of pleural lesion). Pressurometry (occasional vagal raction). During Local Anesthesia, Oxygen mask will provide sensation of comfort to patient.,Main advantages of Local Anesthesia,Allows the surgeon to communicate with the patient. Benefits: Early diagnosis of lesions (radicular / pleural) which might not be diagnosed otherwise. Determine cement injection speed. Anticipate corrective measures. Abort the procedure.,Video (Actual Procedure under Local Anesthesia),Conclusions,PV is a Minimally Invasive Procedure. Surgical Technique may be acquired in a short time. PV