Abstract
Introduction
Osteoporosis is the big problem in the aging human. Among these osteoporotic related fractures, vertebral compression commonly is the main one. Pain and disability pose major problems in these patients. To restore the vertebral height for driving physical stiffness, and loading bearing toward normal limited and control the pain, kyphoplasty with variable filling materials (PMMA, CPC etc.) have been used for the treatment. For decreasing the rate of PMMA leakage in various wall injuries in vertebral compression fracture, we performed kyphoplasty with modified eggshell technique in different characteristics of vertebral wall.
Material and Methods
Twenty-four symptomatic vertebral fractures were enrolled. Visual Analogue Scale, the Oswestry Disability Index and Vertebral Wall Injury Score were assessed. The vertebral height loss and changes of kyphotic angle were also recorded by plain X-ray. Three-dimensional CT will be arranged for evaluating the condition of deficiency vertebral wall and central body collapse if need. After creating cavity by percutaneous bipedicular balloon device, PMMA was injected into weak wall site according the pre-operative evaluation or intra-operative finding. The balloon was once again introduced into the created cavity and inflated to achieve the PMMA shield (regional egg-shell method). Then the PMMA or other materials as CPC materials will be continuously to be fill into the left space. Outcome, fill materials leakage condition, X-ray and CT were reviewed postoperatively.
Results
Symptomatic cement extravasation related complications or leakage on X-ray were not observed in follow up. Only one adjacent compression fracture was happened in one month. Improvement in vertebral height and the mean kyphotic angle was also noted. The mean VAS and ODI decreased significantly from pre-operation to post-operation (p < 0.05). The Vertebral Wall Injury Score reviews also told us the eggshell technique is fit for multiple conditions of wall injury
Conclusion
It's always concerned for the leakage of PMMA during spine surgery. There are many options of new implant for decreasing the rate of leakage. Greene introduces the eggshell technique in 2007, they used the eggshell idea to cover the possible leakage site. They had only 7 patients and those possible cortical defects were noted over superior endplate or lateral wall in their paper. According to our experiences in kyphoplasty with this regional eggshell technique in our 24 patients with various wall injuries. The technique is a safe and significantly functional works for decreasing the leakage of PMMA in various wall injury conditions with experienced surgery operator.