• Journal of Korean Neurosurgical Society
• /
• 제29권5호
• /
• pp.615-622
• /
• 2000

Objective : Percutaneous vertebroplasty is an effective and minimally invasive procedure consisting of the injection of a PMMA(polymethyl methacrylate) into the vertebral body compression fracture with osteoporosis. Matherials and Methods : Twenty-eight procedures were performed for vertebral body compression fractures with osteoporosis in 25 patients(22 women, 3 men). The mean age was 65.9 years old. The inclusion criteria for percutaneous vertebroplasty were 1) acute vertebral body compression fracture with osteoporosis, 2) expected high operative morbidity in old age, 3) no neurologic deficits, 4) no or minimal canal enchroachment, 5) patient refusal of invasive surgery. All patients underwent MR images before the procedure. Under local anesthesia, after the percutaneous needle puncture of the involved vertebra via a transpedicular approach and venography using the water soluble contrast material, PMMA injection was introduced into the fractured vertebral body. Results : The procedure was technically successful in all patients. All patients experienced excellent pain relief (complete pain relief ; 10, marked pain relief ; 14). One patient experienced marked pain relief, however, the patient died during the follow-up period due to stomach cancer. There were twelve paravertebral tissue leaks, twelve paravertebral venous plexus leaks, four epidural leaks and one intradiskal leak, but no clinically significant complications occurred in all patients. Conclusion : Percutaneous vertebraoplasty is a valuable procedure in the treatment of vertebral body compression fracture with osteoporosis, providing immediate pain relief and early mobilization. MRI is the most reliable diagnostic tool for identifying painful fractured vertebral body.

• Journal of Mechanical Science and Technology
• /
• 제15권7호
• /
• pp.1041-1050
• /
• 2001

Control of bone cement volume (PMMA) may be critical for preventing complications in vertebroplasty, the percutaneous injection of PMMA into vertebra. The purpose of this study was to predict the optimal volume of PMMA injection based on CT images. For this, correlation between PMMA volume and textural features of CT images was examined before and after surgery to evaluate the appropriate PMMA amount. The gray level run length analysis was used to determine the textural features of the trabecular bone. Extimation of PMMA volume was done using 3D visualization with semi-automatic segmentation on postoperative CT images. Then, finite element (FE) models were constructed based on the CT image data of patients and PMMA volume. Appropriate material properties for the trabecular bone were assigned by converting BMD to elastic modulus. Structural reinforcement due to the changes in PMMA volume and BMD was assessed in terms of axial displacement of the superior endplate. A strong correlation was found between the injected PMMA volume and the area of the intertrabecular space and that of trabecular bone calculated from the CT images (r=0.90 and -0.90, respectively). FE results suggested that vertebroplasty could effectively reinforce the osteoporotic vertebra regardless of BMD or PMMA volume. Effectiveness of additional PMMA injection tended to decrease. For patients with BMD well lower than 50mg/ml, injection of up to 30% volume of the vertebral body is recommended. However, less than 30% is recommended otherwise to avoid any complications from excessive PMMA because the strength has already reached the normal level.

• Journal of Korean Neurosurgical Society
• /
• 제49권5호
• /
• pp.273-277
• /
• 2011

Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.

• Journal of Korean Neurosurgical Society
• /
• 제29권3호
• /
• pp.365-371
• /
• 2000

Objectives : To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report preliminary results of its use. Methods : The technique was used over a 8-month period in 9 patients with 10 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebrae with a Jamshidi needle via a transpedicular approach followed by injection of polymethylmethacrylate(PMMA) into the vertebral body. Results : The procedure was technically successful in all patients, with an average injection amount of 5.9 cc per vertebral body. One patient complained of flank pain postoperatively in spite of improvement in back pain caused by the fractured vertebra. Remaining eight patients reported significant pain relief early after treatment. The patients were followed up for 3 to 15 months(average 7.2 months) and demonstrated no recurrence of pain or aggravation of deformity. Conclusion : Vertebroplasty appears to be a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients. However, it needs to have more extensive prospective clinical study to confirm its definitive role in the management of this condition.

• Journal of Korean Neurosurgical Society
• /
• 제62권1호
• /
• pp.46-52
• /
• 2019

Objective : The aim of this nationwide study was to analyze the current state of patients with newly diagnosed metastatic spine tumors according to surgical methods. Methods : Data was extracted from the Korean Health Insurance Review and Assessment Service database. Surgery was categorized into three methods : fusion, decompression, and vertebroplasty. Data included patient age, sex, health insurance type, and co-morbidities. Survival rates of metastatic spine tumor patients according to each surgical method were evaluated. Results : Among 1677 patients who had an operation, 823 patients were treated by fusion, 141 patients underwent decompression, and 713 patients were treated by vertebroplasty. The three most prevalent primary tumor sites were the lung, breast, and liver & biliary. On the other hand, the three most prevalent primary tumor sites of patients who underwent surgery were the lung, liver & biliary, and the prostate. The median survival periods for each surgical method in the metastatic spine tumor patients were 228 days for those who underwent surgery, 249 days for decompression, and 154 days for vertebroplasty. Age, sex, and comorbidities significantly affected survival rate. Conclusion : For every primary tumor site, decompression was the least common surgical method during the study period. Although the three surgical methods did not significantly affect the survival period, patients with a poor prognosis tended to undergo vertebroplasty.

• The Korean Journal of Pain
• /
• 제13권2호
• /
• pp.237-241
• /
• 2000

Vertebral compression fractures commonly afflict the elderly. Some patients suffer from severe mechanical pain in spite of treatments with strong analgesics and bracing. Vertebroplasty, which was originally used for vertebral hemangioma, is effective for patients who do not respond to these more conservative treatments. However, the procedure has some risk. Leaks of bone cement into perineural tissues can be a serious complication. In contrast to the lumbar vertebrae, the outer margin of the pedicle of the thoracic vertebrae is almost in line with the outer margin of the body. This, combined with the thinner pedicle of the thoracic vertebrae, makes proper needle placement difficult. The posterolateral approach is preferred to the transpedicular approach in order to avoid the danger of destroying the inner cortex of the pedicle. But there can be a problems with the standard posterolateral approach. The rib can be broken, the pleura can be punctured. A new and safer approach is possible. Before penetrating the bone, the needle is positioned at the upper margin of the transverse process, 5 mm away from the pedicle. To achieve this positioning, the needle must puncture the skin 1~1.5 cm laterally and 3~5 mm cranially to the target point on the bone. This approach was used for 10 patients and we achieved good results with no serious complication.

• Journal of Korean Neurosurgical Society
• /
• 제45권6호
• /
• pp.386-389
• /
• 2009

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

• The Korean Journal of Pain
• /
• 제26권1호
• /
• pp.94-97
• /
• 2013

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the $1^{st}$ and $4^{th}$ (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

• 대한의용생체공학회:의공학회지
• /
• 제24권4호
• /
• pp.369-373
• /
• 2003

골다공증에 의한 척추체의 압박골절은 뼈의 파단성 질병중에서 가장 흔하게 나타나는 증상이다 최근에 척추압박골절에 대한 의학적 치료방법으로 각광받고 있는 척추성형술은 골강화제를 주입함으로써 척추체를 강화하고 변형을 보정하며. 환자의 고통을 줄여준다. 그러나 종전 연구에서는 골강화제가 주입된 후 척추체의 기계적 특성 강화에 대한 연구가 전무했으므로, 본 연구에서는 PMMA의 물성을 바탕으로 돼지와 사체로부터 시편을 얻어 겉보기 밀도에 대한 순수 망상골과 PMMA가 주입된 망상골의 영률을 측정하였다. 겉보기밀도에 따른 영률은 순수망상골의 경우 멱급수의 형태를 가지며. PMMA가 주입된 망상골의 경우 선형적인 형태를 가졌다.

• Journal of Korean Neurosurgical Society
• /
• 제45권6호
• /
• pp.378-380
• /
• 2009

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.