Open kyphoplasty for management of metastatic and severe osteoporotic spinal fracture. Technical note.
OBJECTIVE
Elderly patients in poor general health frequently suffer vertebral body (VB) fractures due to osteoporosis or vertebral metastatic lesions. Kyphoplasty and vertebroplasty have become the standard treatment for these types of fractures. In certain conditions that cause local kyphosis, such as spinal cord compression due to a metastatic epidural tumor or the shortening of the spinal canal secondary to vertebral compression, the surgical treatment should provide decompression and stabilization during a short intervention. In this study the authors evaluated a surgical technique that frequently combines a same-session surgical decompression, such as a laminectomy, and posterior instrumentation-assisted stabilization during the same open intervention in which the VB is stabilized by kyphoplasty.


METHODS
During an 18-month period, the authors treated 18 patients with VB fractures according to this protocol: 14 patients with vertebral metastatic lesions and four with osteoporosis. The patients' mean age was 60 years. All suffered severe pain preoperatively (mean visual analog scale [VAS] score of 7). Fourteen of the 18 patients suffered a neurological deficit. Twenty-three vertebral levels were treated; in 15 patients it was necessary to place posterior instrumentation. The mean duration of the intervention was 90 minutes. Pain in all patients improved 3 days after the intervention, and the mean VAS score decreased to 2. Patients with a neurological dysfunction improved. The mean quantity of injected cement for the kyphoplasty procedure was 7 ml. The mean duration of hospitalization was 7 days. Neuroimaging revealed cement leaks in two cases: one into the disc interspace and one anteriorly into the fractured part of the vertebra. After the intervention, most patients with metastatic lesions underwent radiotherapy. No procedure-related complications occurred.


CONCLUSIONS
This procedure allows decompression of the spinal cord, consolidation of the VB and thus a stabilization of the vertebral column, and may provide an alternative treatment to invasive VB excision in patients in poor general health.
Fuentes
Stéphane
S
Service de Neurochirurgie, Hôpital de la Timone, Marseille, France. sfuentes@ap-hm.fr
Métellus
Phillipe
P
Pech-Gourg
Grégoire
G
Adetchessi
Tarek
T
Dufour
Henri
H
Grisoli
François
F
D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D010024:Osteoporosis / Q000150:complications / Q000601:surgery*; D010147:Pain Measurement; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*