Kyphoplasty. Department of Pr Laredo

1. KYPHOPLASTYB. Hamze, Hassanin. Negila, JD. Laredo Lariboisière Hospital Paris, France
2. KYPHOPLASTY / VERTEBROPLASTY • Objectifs : Vertebroplasty: – Analgisic. – Stabiliser. Kyphoplasty: – Correction of vertebral body deformity – Prevention of secondry cyphosis
3. KYPHOPLASTY / VERTEBROPLASTYM ME YT EA LS • Indications: Debilitating OTA benign or malignant bone M AS diseasesIs -agressive angiomas, -bone metastasis , – myeloma, – Recent osteoporotic fractures, symptomatic, refractory to analgesics treatment Agressive Angioma OSTEOPOROTIC FRACTURES
4. KYPHOPLASTY / VERTEBROPLASTY • PROCEDURE OF THE VERTEBROPLASTY Widely described in the litterature -General anesthesai. -Patient in supine position. -uni ou bi-pedicular accesP. Galibert, H. Deramond Neurochirurgie 1987
5. KYPHOPLASTY • The kyphoplasty may be considered as a moderne vertebroplasty. • It consists of injection of polymethylmetacrylate intra vertebral under flouroscopy, after ballonn dilatation to get recovary of the vertebral body height .
6. KYPHOPLASTY  PROCEDURE OF KYPHOPLASTY:  Local Anesthesia: -Preferable to the patient -Reduce patient movement -Compromis in case of sever Heart disease  General Anesthesia: – Preferable Method -More confortable -Strict supine position
7. KYPHOPLASTY• Procedure: – bi-pediculaire acces – a 11 Gauge needle shouldBe always inside the pediculareye – according to an oblique course of the anteromedial and top to bottom
8. KYPHOPLASTY • PROCEDURE OF THE KYPHOPLASTY: -A needle is placed in the vertebral body
9. KYPHOPLASTY – The hole made by a needle under Flouroscopic control Cannulated mill
10. KYPHOPLASTY• PROCEDURE OF THE KYPHOPLASTY: – The balloons are introduced into the tunnels
11. KYPHOPLASTY- balloons inflated simultaneously
12. KYPHOPLASTY • PROCEDURE OF THE KYPHOPLASTY: – The balloons are deflated then the cement is injected under flouroscopy control in the new cavities formed by the balloon. – The filling is observed under fluoroscopy to and fro
13. KYPHOPLASTY Patient:79 YO Female Diagnosis: Primary osteoporosis Fracture : T-11, 7 weeks old Courtesy of James Hamada, M.D., Torrance, CA
14. KYPHOPLASTY Patient:55 YO Male Diagnosis: Secondary Osteoporotic Fracture : Courtesy of Ulrich Berlemann, M.D., Germany
15. KYPHOPLASTY / VERTEBROPLASTY• COMPLICATIONS: – Fever, inflammatory syndrom NSAID – Pain recurence due local heat – Compression: spinal cord / nerve root (foramen) – Veinous Thrombosis : ciment very liquid
16. KYPHOPLASTY / VERTEBROPLASTY• COMPLICATIONS :- post vertebroplasty CT shows a leakage of the ciment in about more than 70 % of cases – 5 to 7,5 % of these cases are symptomatic, usually well tolerated.
17. KYPHOPLASTIE• COMPLICATIONS of KYPHOPLASTY:• The leakage of the ciment in the kyphoplasty is about 9 %. No symptomatic complicationHas been reported.• This low rate is due to: – The best control of filling of the cavity made by the ballon. -using of an ciment less fluid – and low injection pression.
18. KYPHOPLASTY VERSUS VERTEBROPLASTY CONCLUSION: – The vertebroplasty constits a remarkable progression in the manegment of malignent or symptomatic osteoporotic vertebral fractures . – The kyphoplasty shows low complications rate other than the vertebroplasty in case of osteolytic lesions with cortical destruction.
19. KYPHOPLASTY VERSUS VERTEBROPLASTY CONCLUSION: – The anagesic and fonctional effects is similar in the two techniques. – Actuelly, there is comparesion study of these tow procedures. – The resultats of the kyphoplasty is more discutable , in our experience, the restoration of the vertebral body height was observed in 2 cases of 66.

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