经皮椎体成形术的技术方面的问题.ppt

TechnicalAspectsofPercutaneousVertebroplasty,Dr.CosmeArgerichNeurosurgeon,History,1987:FirstdescriptionbyGalibertandDeramond.2019:FirstprocedureinGeneva(Switzerland).2019FirstreportedprocedureinUSA.,Schools,European38%methastases31%Hemangiomas/Myelomas31%Osteoporosis,NorthAmerican70%Osteoporosis17%Hemangiomas/Myelomas13%Methastases,DemographyUSA,10MillioncasesofOsteoporosis(45%whitefemale50years).700thousandvertebralfractures/year.150thousandhospitaladmissions/year.Totaldirectcosts:U$13.800Millions.Estimatedcostsin2030:60.000Millions.,DiagnosticSequence,IndicationsforPV,Pain/instabilityin:Osteoporoticcollapse.Sub-acutetraumaticcollapse.Malignantvertebraltumors(Metastasis/Myeloma)Vertebralangiomas,Osteoporosis,Intenseandpersistentpostfracturalpain:1to12weeksevolution.Painfocusedonspinalmid-line,relatedtodiagnosedvertebralcollapse.Absence/poorresponsetomedicaltherapy(Alendronate,Calcium,Opiates).QualityofLifeimpairmentduetoopiatessideeffects.,Osteoporosis,T1:signalreductioninD12.,STIR:increasedsignalsuggestingrecentfracture.,Tumors,Highriskofvertebralcollapse.Intractablepain.Markedsideeffectstoopiates:blurredvision,bladder/boweldisorders,confinementtobedrest.Palliativetreatmentinterminalpatients.,MalignantTumors,T1:signalreductioninvertebralbodyandposteriorelements,+C:increasedsignal,Notethat:,Mostofskeletalmetastasisoccurinspine.Upto10%ofcancerpatientspresentsymptomaticspinemetastasis.Courseoflocaldiseasemaybepainfulandinvalidating.,GeneralExclusionCriteria,Local/systemicinfection.Recentfractureofposteriorvertebralwall.Coagulationdisorders.Poorgeneralconditions.Vertebralcollapse8090%.,ParticularExclusionCriteria,Osteoporosis.Adequateresponsetomedicaltreatment.Lackofradiologicalprogressionoffracture.,Cancer:Advancedsystemicdisease.Progressiontospinalchannel.,VertebralApproaches(willvaryaccordingtosurgeonsspecialtyandexperience),CervicalSpine:Anterior.DorsalSpine:Transpedicular.LumbarSpine:Transpedicular.Lateral.,AlternativeApproaches,Latero-transpedicular.Latero-antepedicular.Laterovertebral.,Equipment,Fixed“C”Arm,Advantages:BetterimagequalityEasieroperation,Disadvantages:HighoperationalcostsUsesubjecttoavailability,Mobile“C”Arm,Advantages:LowoperationalcostsAvailability,Disadvantages:LesserimagequalityMoredifficultoperation,Immediateaccessto:CTScanand/orRMI.ICU.OperatingRoom.Mustbeavailableforthetreatmentofpotentialcomplications,Anestesia,Electionwilldependonsurgeonsexperienceandcharacteristicsofpatient.,IntraoperativeMonitoring,EKG.O2Saturation(earlydiagnosisofpleurallesion).Pressurometry(occasionalvagalraction).DuringLocalAnesthesia,Oxygenmaskwillprovidesensationofcomforttopatient.,MainadvantagesofLocalAnesthesia,Allowsthesurgeontocommunicatewiththepatient.Benefits:Earlydiagnosisoflesions(radicular/pleural)whichmightnotbediagnosedotherwise.Determinecementinjectionspeed.Anticipatecorrectivemeasures.Aborttheprocedure.,Video(ActualProcedureunderLocalAnesthesia),Conclusions,PVisaMinimallyInvasiveProcedure.SurgicalTechniquemaybeacquiredinashorttime