168- Kyphoplastie et traumatismes rachidien. - Kyphoplasty and spinal trauma

Franzen (Gant, Belgique)

Kyphoplasty and spinal trauma

Vertebroplasty and kyphoplasty are both minimally invasive surgical procedures for treating recent traumatic fractures where a cement-like material is injected directly into the fractured bone. This stabilizes the non osteoporotic fracture and provides immediate pain relief in many cases. Due to the vertebral collapse the resulting change in height and spinal alignment can lead to serious health problems.
Kyphoplasty includes an additional step. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae. The goal of this step is to restore height to the bone thus reducing deformity of the spine.

In the non osteoporotic traumatic type of fracture, we follow the OA classification to make our indication on treatment. If there is a type A1 recent non osteoporotic fracture (<10° wedge) we wait until the vertebral body heal spontaneously. Control radiography reveals the healing. If there is an evolution in collapse we perform a Vertebroplasty after one month. The fresh complicated fractures without collapse will be treated by Vertebroplasty after one month to ensure the endosteal en periostal healing. If the wedge fracture is more as 15° and there is a maximum fracture type just to Type A3.1 we perform a kyphoplasty immediately with reducing the collapse height and restoration of the kyphosis . This procedure is mostly done with biodegradable cement in contradiction to osteoporotic fracture which is treated with a non biodegradable cement to stabilize the vertebral body. The results are depending on the age, the deformation and type of fracture. We see a restoration of more as 75% in young fracture less as 8 days old and no restoration in fractures older than 3 months. There is an average >5° change in sagittal alignment after kyphoplasty.

The most common complications are leakage 8%, spinal or nerve root injury 0.2% due to incorrect needle placement.the average complication rate is 0,5%. A review of the FDA included one death, five cases of permanent paralysis, radiculopathy, paraesthesia or loss of motor function, and 13 cases of canal intrusion or cord compression.

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