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Title:Zlomi sosednjih vretenc po perkutani avgmentaciji osteoporotičnega zloma vretenca
Authors:ID Movrin, Igor (Author)
ID Komadina, Radko (Mentor) More about this mentor... New window
Files:.pdf DR_Movrin_Igor_2011.pdf (4,79 MB)
MD5: 1DA166D76537642C97B3A5AE6CF6F896
PID: 20.500.12556/dkum/7e29bb5b-9345-49a0-af3b-7b90d3cfd08c
 
Language:Slovenian
Work type:Dissertation
Organization:MF - Faculty of Medicine
Abstract:Uvod: Osteoporotični zlomi vretenc so vse pogosteje zdravljeni minimalno invazivno z eno od metod perkutane avgmentacije, z balonsko kifoplastiko (BK) ali vertebroplastoko (VP). Obe metodi naj bi bili uspešni pri odpravi bolečin, obstaja pa sum povečanega vpliva obeh metod na zlome sosednjih vretenc. Še vedno ostaja nejasno, ali so zlomi sosednjih vretenc po BK in VP posledica povečane togosti vretenca kot posledica same avgmentacije ali pa so preprosto posledica napredovale osteoporoze. Po objavljenih podatkih naj bi izliv cementa v medvretenčni prostor povečal tveganje za zlom sosednjega vretenca. Namen raziskave je bil oceniti tveganje za zlom sosednjega vretenca po opravljeni BK v primerjavi z VP in določiti možne dejavnike tveganja za zlome sosednjih vretenc. Bolniki in metode: Triinsedemdeset bolnikov z bolečimi osteoporotičnimi zlomi vretenc je bilo vključenih v prospektivno nerandomizirano raziskavo. BK je bila opravljena pri 46 bolnikih (51 vretenc) in VP pri 27 bolnikih (32 vretenc). Na prvem pregledu bolnikov po utrpelem OZV smo predooperativno opravili klinične in radiografske preiskave. Pooperativni kontrolni pregledi, zajeti v analizi rezultatov, so bili prvi pooperativni dan in 1 leto po opravljeni avgmentaciji. V kontrolno skupino smo vključili bolnike z OZV z manjšo lokalno kifoze (<15°) in brez hujše bolečnosti. Te bolnike smo zdravili na konzervativen (neoperativen) način (ortoza, analgetiki). Rezultati: Eno leto po ugotovljenem OZV je do zloma sosednjega vretenca prišlo pri 3 od 46 (6.5%) bolnikov, zdravljenih z BK in pri 2 od 27 (7.4%) bolnikov, zdravljenih z VP. V kontrolni skupini konzervativno zdravljenih bolnikov je v 1 letu do zloma sosednjega vretenca prišlo pri 10 od 64 bolnikov (21.7%). Kot pomembna napovedna dejavnika za zlom sosednjega vretenca sta se izkazala stopnja lokalne kifoze in MKG. Pri operativno zdravljenih bolnikih z MKG ≥-3.0 je prišlo do zloma sosednjega vretenca v večjem deležu (4/20, 20%) kot pri bolnikih z MKG <-3.0 (1/53, 2%) (p=0.011). Bolniki, ki so imeli pooperativno lokalno kifozo <9°, so doživeli zlom sosednjega vretenca v manjšem deležu (1/52, 2%) kot bolniki z lokalno kifozo ≥9° (4/21, 19%) (p=0.013). Obeti za zlom sosednjega vretenca so bili pri bolnikih z višjo stopnjo pooperativne lokalne kifoze (≥9°) 12-krat (95% IZ: 1.25-114.88) večji kot pri nižji stopnji kifoze (<9°), ter 13-krat (95% IZ: 1.35-124.81) večji pri višji T vrednosti MKG (≥-3.0) kot pri nižji (<-3.0). V nobenem primeru zloma sosednjega vretenca nismo ugotavljali intervertebralnega izliva cementa. Z avgmentacijo dosežena pooperativna poprava kota kifoze je bila signifikantno večja pri BK v primerjavi z VP (7.7 ± 4.5 oz. 2.3 ± 2.3) (p=0.001). V obeh skupinah je po operativnem posegu prišlo do bistvenega upada VAS vrednosti (mediana predoperativna vrednost VAS obeh skupin=9). Bolniki obeh skupin so po operativnem posegu stopnjo bolečine ocenili podobno (mediana VAS vrednost=2). Pri konzervativno zdravljenih bolnikih je utrpelo zlom sosednjega vretenca 9/39 (23%) bolnikov z lokalno kifozo ob zlomu prvega vretenca ≥5.0° in le 1/22 (5%) bolnikov z lokalno kifozo ob zlomu prvega vretenca <5.0° (p=0.061). Med bolniki z MKG ≥ -2.6 je imelo zlom sosednjega vretenca 8/31 (26%) bolnikov, med bolniki z MKG < -2.6 pa 2/30 (7%) bolnikov (p=0.044). Obeti za zlom sosednjega vretenca so bili pri bolnikih z višjo stopnjo lokalne kifoze (≥5.0°) ob ugotovljenem zlomu prvega vretenca 6.3 krat (95% IZ: 0.74, 53.54) (p=0.092) večji kot pri bolnikih z nižjo stopnjo lokalne kifoze (<5.0°), ter 4.87 krat (95% IZ: 0.94, 25.22) (p=0.059) večji pri bolnikih z višjo T vrednostjo MKG (≥ -2.6 ) kot pri bolnikih z nižjo T vrednostjo MKG (< -2.6). Zaključek: Naši rezultati kažejo, da sta BK in VP metodi z nizkim tveganjem za zlom sosednjega vretenca. Najpomembnejša dejavnika tveganja za zlom sosednjega vretenca po perkutani avgmentaciji OZV sta stopnja osteoporoze in spremenjena biomehanika hrbtenice kot posledica lokalne kifoze. Na podlagi p
Keywords:Balonska kifoplastika, Mineralna kostna gostota, Osteoporoza, Primerjalna analiza, Vertebroplastika, Zlom sosednjega vretenca
Place of publishing:[Maribor
Publisher:I. Movrin]
Year of publishing:2011
PID:20.500.12556/DKUM-21136 New window
UDC:61
COBISS.SI-ID:259143424 New window
NUK URN:URN:SI:UM:DK:7FKTZYOE
Publication date in DKUM:28.11.2011
Views:4803
Downloads:372
Metadata:XML DC-XML DC-RDF
Categories:MF
:
MOVRIN, Igor, 2011, Zlomi sosednjih vretenc po perkutani avgmentaciji osteoporotičnega zloma vretenca [online]. Doctoral dissertation. Maribor : I. Movrin. [Accessed 4 April 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=21136
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Secondary language

Language:English
Title:Adjacent vertebral fractures after percotaneous vertebral augmentation of osteoporotic vertebral fracture
Abstract:Introduction: Osteoporotic vertebral fractures are being increasingly treated with minimally invasive bone augmentation techniques such as balloon kyphoplasty (BK) and vertebroplasty (VP). Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent vertebral fractures after such procedures. It is still controversial whether adjacent level fractures after BK and VP should be regarded as the consequence of stiffness achieved by augmentation with bone cement or if the adjacent level fractures are simply the result of the natural progression of osteoporosis. It was reported that cement leakage into the disc increases the risk of new fracture of adjacent vertebral bodies. The purpose of this study was to evaluate the adjacent level fracture risk after BK as compared with VP and to determine the possible dominant risk factor associated with adjacent level fractures. Materials and methods: Seventy-three patients with painful osteoporotic vertebral fractures were enrolled in a prospective nonrandomized study. BK was performed in 46 patients (51 vertebral bodies) and VP in 27 patients (32 vertebral bodies). The first patient’s visit was before the operative procedure, when clinical and radiographical examinations were done. The follow-up visits, considered in the analysis, were on the first day and after 1 year, postoperatively. The control group included patients with osteoporotic vertebral fractures with lower rates of local kyphosis (<15°) and without severe pain. These patients were treated with conservative nonsurgical procedures (orthosis, analgetics). Results: In 3 out of 46 patients (6.5%) treated with BK and in 2 out of 27 patients (7.4%) treated with VP adjacent level fracture occurred within 1 year after diagnosed osteoporotic vertebral fracture. Within a 1-year period there were 10 out of 64 (21.7%) patients of the control group (conservatively treated patients) with adjacent level fractures. The degree of local kyphosis and bone mineral density (BMD) were identified as important predictive factors for adjacent level fracture. In surgically treated patients with BMD ≥-3.0 adjacent level fractures occurred in a greater extent as in patients with BMD <-3.0 (1/53, 2%) (p=0.011). Adjacent level fracture occurred in a lesser extent (1/52, 2%) in patients with postoperative local kyphosis <9° as in patients with local kyphosis ≥9° (4/21, 19%) (p=0.013). The prospects for an adjacent level fracture in operatively treated patients with higher rates of postoperative local kyphosis (≥9°) were 12 times greater (95% CI: 1.25-114.88) than in patients with lower rates of local kyphosis (<9°). Moreover, they were13 times greater (95% CI: 1.35-124.81) in patients with higher T-value of BMD (≥-3.0) than in patients with lower T-values of BMD (<-3.0). We did not found any intradiscal cement leakage in cases with adjacent level fractures. The postoperative mean kyphotic angle improved significantly better in patients treated with BK compared with patients treated with VP (7.7 ± 4.5 vs. 2.3 ± 2.3) (p=0.001), and in both groups, the mean VAS score fell dramatically from the baseline (preoperative) value of about 9 to the value of about 2 immediately post OP. Adjacent level fractures occurred in 9 out of 39 (23%) conservatively treated patients with local kyphosis ≥5.0° following first vertebral fracture and only in 1 out of 22 (5%) patients with local kyphosis <5.0° following first vertebral fracture (p=0.061). Among patients with BMD ≥ -2.6, 8 out of 31 (26%) patients had adjacent level fracture, while among patients with BMD < -2.6 only 2 out of 30 (7%) patients had adjacent level fracture (p=0.044). The prospects for an adjacent level fracture in conservatively treated patients with higher rates of local kyphosis (≥5.0°) following the diagnosis of the first vertebral fracture were 6.3 times greater (95% CI: 0.74, 53.54) (p=0.092) than in patients with lower rates of local kyphosis (<5.0°). Moreover, they were 4.87 times greater (
Keywords:Adjacent vertebral fracture, Bone mineral density, Comparative analysis, Kyphoplasty, Osteoporosis, Vertebroplasty


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