Revision strategies for complications and failure of vertebroplasties
Revision strategies for complications and failure of vertebroplasties
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DOI：
10.1007/s00586-008-0680-3
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发表时间：
2008-07-01
影响因子：
2.8
通讯作者：
Chung, Kao-Chi
中科院分区：
文献类型：
--
作者：
Yang, Shih-Chieh;Chen, Wen-Jer;Chung, Kao-Chi
经皮椎体成形术在治疗椎体压缩性骨折中被广泛讨论，但很少有关于该技术失败后的补救手术的报道。我们研究了22例经皮椎体成形术患者，这些患者在术后出现新症状后需要进行翻修手术。翻修手术的适应症包括药物治疗无效的复发性顽固性背痛、感染性脊柱炎、骨水泥渗漏伴神经功能缺损和骨水泥移位和/或碎裂。5例患者接受了最初骨水泥固定椎体的重复经皮椎体成形术。17例患者接受了前路、后路或前后路联合手术。4例患者因骨水泥增强效果不佳、前路植骨下沉或内固定器械拔出而需要第三次手术。最后，4例（18%）患者接受了重复椎体成形术，2例（9%）患者仅接受了前路手术，1例（5%）患者仅接受了后路手术，15例（68%）患者接受了前后路联合手术;除1例外，所有患者均恢复了与手术前相当的行走状态。总之，经皮椎体成形术是一种简单有效的治疗椎体压缩性骨折的方法，但并非无风险或无并发症。脊柱外科医生应熟悉翻修手术的各种入路和技术。联合前路和后路手术似乎是治疗经皮椎体成形术最初失败的严重椎体狭窄患者的最安全的挽救方法。
Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk- or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.