RISKS AND COMPLICATIONS OF PERCUTANEOUS VERTEBROPLASTY AND KIPHOPLASTY IN VERTEBRAL TUMORS

Abstract

Objectives. The purpose of this work is to evaluate the risks and complications of vertebroplasty and kiphoplasty in patients with primary and secondary vertebral tumors, as well as the clinical differences between augmentation techniques and / or other treatment options. Materials and method. For this work, a retrospective study was conducted, between December 2012 and December 2015, which included a batch of 32 patients, 21 of them undergoing percutaneous vertebroplasty, and for 11 there was kiphoplasty. The patients were admitted to the Sanador Hospital, Neurosurgery Department, and the Orthopedics-Traumatology Clinical Hospital and osteoarticular TB „Foisor“ from Bucharest and received indication of percutaneous vertebroplasty and kiphoplasty. In order to have access to the archive with the medical documents, the agreement of the hospital managers was obtained. The data were obtained from the observation sheets of the patients admitted during this period in the mentioned hospitals, the clinical data of each patient being evaluated, together with an imagistic confirmation of the diagnosis. Results. All the cases were technically successful, being very well tolerated by the patients, being discharged with good general condition and significantly improving the symptomatology. At the postoperative controls, of the total of 32 patients, 11 had complications. Postoperative evaluation was performed by radiographs of the spine and native spine CT with bone window and 3D reconstruction. Clinical follow-up data, over a 12-month period, were available for all 32 patients, detailed at 1, 3, 6, and 12 months after VPP (percutaneous vertebroplasty) and kiphoplasty and evaluated with assessment scales: visual analogue scale, Oswestry Disability Score Index and Karnofsky Performance Scale. Of the 21 cases of vertebroplasty, 3 of the patients (14%) had postoperative complications as follows: in one case there was a leakage of cement in the puncture pathway, 1 patient stated the persistence of pain, and 1 patient had allergic reactions. Of the 11 cases of kiphoplasty, 3 patients (27%) had postoperative complications: in 2 cases the cement leakage occurred, and one of the patients had an allergic reaction to the materials used. Discussions. The results of this study demonstrated the high success rate of these 2 surgical methods, with decreased pain intensity, improved Oswestry score and improved quality of life in these patients, who could resume their activity quickly after performing the surgery. Although initially patients opted for analgesic treatment and rest, their benefit was limited, in the end surgery was required. Conclusions. Vertebroplasty or kiphoplasty are therapeutic options that should be considered in patients with spinal tumors, but with no signs of spinal cord compression or spine instability. The main advantage of kiphoplasty compared to vertebroplasty is the more controlled placement of the cement. The data available in the literature are limited, without strong conclusions regarding the comparative benefits. The procedures allowed a significant improvement in pain intensity and mobility, a significant reduction in vertebral collapse and kyphotic deformation, and a reduction in the risks of new vertebral fractures, as well as a significantly reduced hospitalization, with a significant reduction in patient costs.

Keywords

• vertebral tumors
• percutaneous vertebroplasty
• kiphoplasty