Treatment Of Multiple-level Vertebral Body Compression Fractures With Osteoporosis With Percutaneous Vertebroplasty Combined With Percutaneous Kyphoplasty

Background and Objective: With the aging of the popuiation,the incidence of vertebral compression fractures with osteoporosis is significantly increasing. The treatment of it with percutaneous vertebroplasty or percutaneous kyphoplasty achieved good efficacy. But it there are advantages and disadvantages. The operation of percutaneous vertebroplasty is simple and the time of operation is short. On the other hand the therapeutic costs is low . The disadvantages are the high occurrence of polymethylmethacrylate leakage and poor function of resetting vertebral height. The operation of percutaneous kyphoplasty is relatively complicated and the time is long.The therapeutic costs is high. As to percutaneous vertebroplasty. The occurrence of polymethylmethacrylate leakage is low and the strong function of resetting vertebral height. Affected by above factors, it is difficult in the treatment of multiple-level osteoporotic vertebral body compression fractures only with PVP or PKP. But PVP combined with PKP can avoid these drawbacks. It can complete the operation of multiple-level vertebral body simultaneously. In this study, to evaluate the methods and efficacy.Methods:The 15 cases (3 men and 12 women) taking prone position or lateral recumbent position sufferring from pereutaneous vertebroplasty and percutaneous kyphoplasty guide by C-arm fluoroscopy. The puncture of vertebral bodies at the same time or double. Polymethylmethacrylate was injected at the same time or step by step. Injected dexamethasone from 10 milligram to 20 milligram before balloon expansion or injection of polymethylmethacrylate. The age range from 65 to 80 years; And the vertebral body compression fractures range from 3 to 10; The operated vertebrae range from 3 to 6. To observe the subjective satisfaction of patients and improvement in VAS and MDS after three days of operation and the follow-up visit. All data acquired was statistically analyzed.Result:The 8 cases were taken prone position and the other 7 cases were taken lateral recumbent position. All cases were completed operation successfully by unilateral puncture.Time consumed from 58 minutes to 105 minutes the average is 75 minutes. The amount of polymethylmethacrylate injected into each vertebral body was from 0.5 millilitre to 9.0 millilitre and the average amount was 3.5 millilitre. The amount injected into each personel was from 6.5 millilitre to 22.5 millilitre and average was 11.5 millilitre. Polymethylmethacrylate leakage occurred in 2 cases(one case of leakage into disc, one case of leakage into paravertebral tissue). The leakage rate was 13%.There were no symptoms after postoperation and follow-up visit.14 cases were very satisfacted with the superior efficacy and 1 case accepted the efficacy. Pain disappeared nearly and were ambulatory in all 15 cases in 48 hours postoperatively. VAS score was distinctly decreased from (7.1±1.2) pre-operation to (2.3±0.6) at 3 days after operation and the follow-up visit was(1.6±0.6)(P<0.01). MDS score was distinctly decreased from (2.0±0.9) pre-operation to (0.9±0.7) at 3 days after operation with a significant difference(P<0.01), the follow-up visit was (0.8±0.7) with no different that of 3 days after operation(P﹥0.05) .There was no relapse of back pain and related complication after 4 to 12 months follow-up visit.Conclusion:Treatment of multiple-level vertebral body compression fractures with osteoporosis with percutaneous vertebroplasty and percutaneous kyphoplasty is safe but clinical efficacy is satisfactory and the complication is low. Also it can reduce the medical costs for patients compared with sub-second operation. Multiple-level vertebral body can be completed the operation of the same time.