The Spinal Canal And Paravertebral Air Bubble Complication Of Intraoperative Percutaneous Vertebroplasty And Percutaneous Kyphoplasty(with19Cases Of Summary)

Objective:Percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty (PKP) is a minimally invasive method of treating of vertebral compression fractures. A retrospective summary of the percutaneous vertebroplasty and kyphoplasty (PVP/PKP) with osteoporotic fractures which occurred spinal and paraspinal air bubble complications, analyze the reason and provide prevention reference for this complications.Methods:March2011to February2012, A total of432OPF patients (648vertebrae) had vertebroplasty(PVP/PKP). Include72males and360female. Age55-92years, mean age71.8years old. Surgery vertebral body from T3to S1, include87PVP cases of259vertebral bodies and345PKP cases of389vertebral bodies. The PVP were positioning disease vertebra with C-arm, sterilization and anesthesia, Under the fluoroscopic puncture,T3to T10with Pedicle rib head gap Puncture way, and T11to L5 with pedicle way. With (11-14) G of vertebroplasty needle Puncture to1cm about away from the anterior vertebral. Use Special putter Bolus injection of bone cement(polymethyl methacrylic,PMMA),1.5ml of each tube,Slow bolus the bone cement, Suture a needle after the PMMA good distribution, end of surgery. After the PKP puncture, Use a balloon catheter system of Vertebral expansion (KMC system) to expansion, pressure (100-300)Psi, Slow bolus the bone cement, Perspective distribution, end of surgery after suture a needle. Observed the Intraoperative and postoperative of patients with lower extremity symptoms, vital signs, VAS score changes. Take X-ray and CT inspection postoperative timely. follow-up2to25months(average12.8months). Summary tair bubble patients(Air bubble, AB) of the vertebral body, spinal canal and paravertebral with vertebral segment distribution, analyze the incidence of AB and which distribution location, and the relationship with vertebral posterior wall rupture rate,the relative position of the needle tract in the pedicle, leakage of bone cement, the injection quantity of bone cement, and the pressure PKP surgery.Results:The first postoperative day had372cases VAS score <3, the rate of Instantly ease86.1%(372/432), Decreased VAS score range of0to7.6. Other60cases were almost relieved in the5th postoperative day. Delay response rate was13.9%(60/432), All the patients VAS score <3 points in the5th postoperative day. The postoperative CT scans found the vertebral body and around of gas, a total of19cases (except1cases of preoperative CT showed the clearance of the psoas muscle-like gas), The AB incidence:4.62%(20/432),19cases of AB patients vertebral distribution as this:2cases of T5,1case of T8,3cases of T10,5cases of T12,4cases of L1,4cases of L2. Air bubble diameter from lmm to6.5mm, the AB of intraspinal (IAB) had12patients, six cases found gas in bone cement, and one cases Within the disc space had bubble. Two cases of12IAB have symptoms, incidence rate0.46%(2/432), One cases of lower limb pain, the other with lower limb paralysis, lower limbs muscle strength as Class I, both of them symptoms disappeared in the postoperative6-24hours. AB patients’ puncture channel in the relative position within the pedicle:4cases of pedicle central lateral side(21.1%),5cases of pedicle central (26.3%),10cases of pedicle Central medial (52.6%).13cases occurred in19cases of AB patients intraoperative fluoroscopy leakage of bone cement(include six cases of disc leakage, four cases of paravertebral leakage, three cases of Paravertebral venous leakage), Postoperative CT scan found a total of27cases of patients with bone cement leakage, including three cases of intraspinal occupying patients, three cases of PMMA leakage and AB patients, However, the leakage of bone cement were no associated symptoms. AB patients’ vertebral injection PMMA volume (2-6.0)ml, an average of4.6ml. The AB patients had6cases of PVP and13cases of PKP, and the PKP pressure (150-300) psi.Conclusion:Osteoporotic vertebral fractures take PVP/PKP can cause vertebrae and spinal canaland air bubble(AB) complications. AB can led to spinal cord and nerve root compression clinical manifestations; Its mechanism is not clear, May be related to the type of vertebral fractures and surgical operations.