Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty.
OBJECTIVE
The purpose of this study is to evaluate the effects of multilevel balloon kyphoplasty (BK) on blood pressure, blood gases and cement leakage.


METHODS
This is a prospective study of 63 patients: 31 were treated for osteoporotic vertebral compressive fractures (OVCF) and 32 for osteolytic tumors (OT). Twenty-six patients were treated at 1 level, 15 at 2, 2 at 3, 6 at 4, 3 at 5, 4 at 6, 5 at 7 and 2 at 8. PPMA was used in 43 patients and calcium phosphate in 20. All patients were treated under general anesthesia with continuous invasive monitoring of hemodynamic changes, arterial blood gases and peripheral and regional cerebral oxygen saturation.


RESULTS
Two patients had a transient drop in blood pressure between 21 and 42 % during simultaneous inflation of all four balloons at two levels and three more patients during cement injection (two PMMA, one calcium phosphate). Five patients had a cement leak (7.9 %), which was unrelated to the cement type or number of levels. Blood pressure, end-tidal carbon dioxide partial pressure and arterial oxygen partial pressure decreased statistically, but without any clinical significance after cement insertion. Peripheral and regional cerebral oxygen saturation remained unchanged. One-way ANOVA revealed no difference between these changes when clustered by the groups single level, two levels and three or more levels.


CONCLUSIONS
BK performed under general anesthesia appears to be safe when applied in multiple levels in the same seating provided the balloons are inflated sequentially and not simultaneously and the cement is inserted slowly in a very doughy state. Close monitoring of cardiorespiratory factors is valuable. Its rare circulatory effects are unrelated to the number of levels or the cement type.
Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Voutes, 71003, Heraklion, Crete, Greece. katonis@hol.gr
Pavlos
P
Katonis
Alexander
A
Hadjipavlou
Xenia
X
Souvatzis
Michael
M
Tzermiadianos
Kalliopi
K
Alpantaki
James Walt
JW
Simmons
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000601:surgery; D005260:Female; D050815:Fractures, Compression / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery; D012119:Respiration; D016103:Spinal Fractures / Q000601:surgery*; D055815:Young Adult
D001843:Bone Cements