74
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
74-79
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The results of treatment using puncture vertebroplasty in 81 patients with various diseases of the thoracic and lumbar
vertebrae are presented. The purpose of this study is to study the effectiveness of vertebroplasty in osteoporotic
fractures of the thoracolumbar spine. Treatment of traumatic spinal injury is an urgent problem of modern
neurosurgery. The work is devoted to the surgical treatment of uncomplicated compression fractures using the
method of puncture vertebroplasty. The results of treatment of 81 victims were analyzed. The high efficiency and
safety of puncture vertebroplasty were noted.
KEYWORDS
Compression fractures of vertebral bodies, diagnostics, puncture vertebroplasty.
INTRODUCTION
Osteoporosis is a systemic metabolic disease of the
skeleton in which decreased bone mass and
microstructural changes in bone tissue lead to
decreased bone strength and an increased risk of
fracture [4].
Research Article
PUNCTION VERTEBROPLASTY WITH BONE CEMENT FOR
OSTEOPORTIC FRACTURES OF THE VERTEBRAS
Submission Date:
February 28, 2022,
Accepted Date:
March 20, 2022,
Published Date:
March 31, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue03-15
Sattorov Alisher Raimovich
National Rehabilitation and Prosthetics Centre for Persons with Disabilities of the Republic of Uzbekistan
Rakhmonov Khurshid Mamadievich
National Rehabilitation and Prosthetics Centre for Persons with Disabilities of the Republic of Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
75
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
74-79
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Every minute in Russia, seven vertebrae are fractured
due to osteoporosis. Only one third of these are
diagnosed; approximately 750,000 vertebral fractures
with osteoporosis are diagnosed annually in the US.
The prevalence of vertebral div fractures with
osteoporosis in Uzbekistan averages 15%. The most
common
complications
of
osteoporosis
are
"uncomplicated" fractures of the thoracolumbar spine
accompanied by severe pain syndrome [9,11].
Osteoporosis occurs most commonly in patients on
long-term steroid therapy and in postmenopausal
women. 16% of women in this period have one or more
vertebral compression fractures. Patients with these
fractures experience severe pain that causes disability
despite conservative therapy [2,8,11].
Back pain is one of the most pressing problems of
modern neurology. This is primarily due to the high
incidence of this pathology. According to statistics, 60
to 80% of the able-bodied population suffer from
lumbosacral pain [6]. According to Batysheva et al., in
2003 in Moscow this group of diseases was the cause
of almost 380 thousand days of temporary disability
and almost 1,700 primary cases of permanent disability
[2]. The currently used surgical and functional
treatment methods for osteoporosis fractures cannot
be applied in all cases in the treatment of patients,
especially in the older age group. And the available
medications used in the treatment of osteoporosis are
expensive and do not allow for pain relief in the acute
period of injury. In the late 1980s, vertebroplasty with
bone cement was developed in France and became
widespread for oncological and traumatic lesions of
the spine [1,3,5]. Bone cement vertebroplasty is used
as an independent surgical treatment or in addition to
other techniques. However, it has not been widely
used for osteoporotic fractures to date due to the lack
of clear indications, algorithms for examination and
selection of patients, and prediction of treatment
outcomes [12].
In recent decades, neurosurgeons' interest in
minimally invasive interventions on the spine has
increased dramatically. Such aspirations are primarily
driven by the desire to reduce surgical trauma: to
minimize postoperative pain, hospitalization and
incapacity of the patient, and thus, the costs of surgical
treatment. Minimally invasive accesses to all parts of
the spine have been developed. Percutaneous
vertebroplasty is currently the method of choice in the
treatment of osteoporotic fractures [10].
The aim of this study was to investigate the
effectiveness of vertebroplasty for osteoporotic
vertebral fractures.
MATERIAL AND METHODS
During examination and treatment of 81 patients with
osteoporotic fractures of the thoracolumbar vertebrae
in the National Center for Rehabilitation and
Prosthetics of the Disabled of the Republic of
Uzbekistan were under observation for 2020-2021.
We observed 81 patients with uncomplicated fractures
of lower thoracic and lumbar vertebral bodies against
the background of osteoporosis. The group consisted
of patients aged 55 to 80 years. They were admitted in
the first hours and days and up to 4 weeks after injury.
According to X-ray data, fractures were localized at
Th3-Th12 level in 38 (47.0%) and L1- L5 in 43 (53.0%)
vertebrae. There were isolated fractures of one
vertebral div in 22 patients. In 59 patients there were
multiple fractures: in 39 patients the bodies of two
adjacent vertebrae; in 13 patients compression
fractures of the bodies of three adjacent vertebrae; in
7 patients the bodies of 3 or more adjacent vertebrae.
76
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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03
Pages:
74-79
SJIF
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FACTOR
(2020:
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286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
The patients' complaints were divided into specific
ones: blunt pain in the area of vertebral deformity in 41
(50.6%); changes in the shape of the spine (kyphotic
deformity, the appearance of stooping, reduction in
height) in 9 (11.1%); the appearance of hump in 7 (8.6%);
pain and heaviness in the thoracic and lumbar spine
(lumbar osteoporosis) in 24 (29.7%) patients.
Preoperative examination included assessment of the
patients'
general
condition,
orthopaedic
and
neurological statuses, and radiological diagnostic
methods: densitometry, CT scanning, and, when
indicated, MRI. According to densitometry, a decrease
in the T-criterion was noted in all patients down to 2-
2.5, which indicates severe osteoporosis. The mean
admission score in the patients observed was 56
(69.1%), corresponding to severe pain.
RESULTS AND DISCUSSION
Vertebroplasty was performed under local anesthesia
transcutaneously, transpedicularly, with Stryker
contrast cement - Simplex with barium (1:10 to parts of
dry cement) being injected on both sides. We use
Stryker trocars and PCD systems to prepare and inject
the cement. During the operation cardiovascular and
respiratory system monitoring is mandatory. The
addition of sedation is possible. During the
postoperative period concomitant diseases were
treated, if necessary, medical gymnastics was done,
individual selection of the osteotropic antiresorptive
therapy was made.
Surgery technique. The patient's position on the
operating table was lying on the abdomen. All
vertebroplasty operations were performed by the
surgeon under local anesthesia (0.5% novocaine
solution), with the anesthesiologist's supervision. The
surgery was performed under radiological monitoring.
Transpedicular access was used in all cases. The EOP
was installed in the straight projection and the trocar
needle insertion points were marked along the
paravertebral lines.
On the skin, the insertion point should be located 1.5-
2.5 cm to the outside of the projection of the base of
the stem of the injured vertebra, in order to give the
necessary convergence. Anaesthesia is administered
from one or both sides, using standard needles and 10-
20 ml syringes. The anaesthetic is injected up to the
bone.
Under EOP control, an 11G bone biopsy needle was
inserted into the anterior aspect of the vertebral div.
Polymethyl methacrylate powder (SIMPLEX, CARL
STORZ) was mixed with solvent and filled into regular
5 ml syringes threaded to the needle. When the bone
cement reached paste consistency, it was slowly
injected into the vertebral div under fluoroscopic
control. The injection was continued until the cement
reached the cortical bone or resistance was noted. If
the filling of half of the vertebral div was inadequate,
a second needle was placed in it on the other side and
additional cement was filled.
The vertebral div was filled with bone cement as
completely as possible. Control radiographs were
taken after vertebroplasty. Surgery was performed on
one level in 36 patients, on two levels in 27 patients,
and on three levels in 18 patients. The dynamics of pain
and activity after vertebroplasty did not depend on the
degree of vertebral div compression. The average
volume of cement injected during percutaneous
vertebroplasty into the vertebral div was 5 ml (1 to 7).
Grade I compression or wedge-shaped vertebral div
deformation, where the height of the vertebral div or
its anterior segments was reduced by less than 1/2 of
the original height, was found in 58 patients, Grade II
was reduced by 1/2 of the original height in 18 patients,
77
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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03
Pages:
74-79
SJIF
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FACTOR
(2020:
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)
(2021:
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64
)
(2022:
6.
319
)
OCLC
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1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
and Grade III was reduced by more than 1/2 of the
original height in 5 patients.
Spine radiography was performed in all patients, but it
often does not provide a complete picture of the
extent of injury and the nature of the fracture, so it
does not allow choosing the optimal treatment tactics.
Spondylography is also insufficiently informative to
detect spinal cord compression by bony fragments of
vertebral bodies or arches, although we consider it a
mandatory diagnostic procedure for traumatic injuries,
since its performance allows an objective assessment
of the condition of bony structures.
Computed tomography (CT) and magnetic resonance
imaging (MRI) were performed in all spinal trauma
victims. The CT scan allows the most accurate
assessment of the vertebral bone condition and the
feasibility of SP. With its help it is possible to detail the
fracture(s): establish the level, number of damaged
vertebrae, identify fractures of arches, articular
processes, vertebral bodies, determine the length of
fracture lines. Simple vertebral div compression
fractures revealed fractures within the spongy tissue.
The contour of the vertebral div was unchanged in all
observations and the integrity of other bone structures
was not disturbed. Particular attention was paid to the
presence of fractures in the posterior wall of the
vertebral div, since such changes can cause epidural
leakage of bone cement during RV.
The high effectiveness of SP was confirmed by the
restoration of motor activity in all patients, although all
patients had limited mobility in the sitting (64) or lying
position (17) before surgery. However, when such high
results are cited, careful selection of patients for SP
should be pointed out, since in the presence of multiple
lesions (not only of the spine), it would be extremely
difficult to assess the effectiveness of the method.
According to our study, a decrease in pain intensity
from 6-10 to 1-3 points was noted in all patients within
the first day after surgery.The patients were activated
on the first day after surgery. Non-steroidal anti-
inflammatory drugs were administered during the
activation period if indicated. Lightweight orthoses
were used in some cases, but their use was not
mandatory. The average postoperative spinal pain
score on the VAS scale was 0.1, which corresponded to
the term "discomfort". This group of patients was
monitored up to 36 months after vertebroplasty.
No patient showed signs of instability at the level of
vertebroplasty performed. Stabilization of the spine
was accompanied by pain relief in 13 patients. Pain
from other spinal segments was observed in 5 patients,
with an average intensity of 23 VAS points, which
corresponds to moderate pain. No recurrence of
vertebral div fractures at the level of the performed
vertebroplasty was observed in our patients. All
patients were discharged several hours after the
control CT scan of the area of interest.
No increase in the kyphotic deformity of the spine was
detected radiologically either. Neurological symptoms
corresponded to the preoperative level, and we did not
observe any irritation of the spinal roots at the level of
vertebroplasty. Individual selection of osteotropic
drugs, physical therapy and an active lifestyle
prevented the progression of osteoporosis. Good
results were obtained in 78 patients, satisfactory in 2
and poor in 1.
CONCLUSIONS
Percutaneous vertebroplasty is thus an effective
treatment for uncomplicated vertebral compression
fractures with osteoporosis, providing reliable spine
78
Volume 04 Issue 03-2022
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(2022:
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)
OCLC
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Publisher:
The USA Journals
stabilization with pain relief, and significantly
improving the quality of life of the victims.
Percutaneous vertebroplasty is a minimally invasive
and highly effective technique for treating various
vertebral div disorders. At the same time, it requires
a highly skilled surgeon and constant monitoring by
means of radiation diagnostics methods, because
neglecting them can lead to clinical complications, up
to urgent surgical interventions.
Using new treatment modalities makes it easier for the
surgeon to perform a puncture vertebroplasty more
appropriately and avoid complications. The treatment
of vertebral div injuries of various etiologies requires
a differentiated approach based on knowledge of the
pathogenetic mechanisms of composite materials on
bone tissue.
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(ISSN
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VOLUME
04
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SSUE
03
Pages:
74-79
SJIF
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FACTOR
(2020:
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)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
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7.569
Publisher:
The USA Journals
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