Hoh Brian L, Rabinov James D, Pryor Johnny C, Hirsch Joshua A
Endovascular Neurosurgery, Interventional Neuroradiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Pain Physician. 2004 Jan;7(1):111-4.
Percutaneous balloon kyphoplasty, like percutaneous vertebroplasty is a therapeutic intervention for painful osteoporotic vertebral body compression fracture. The procedure involves placement of bilateral inflatable balloon tamps in the fractured vertebral body via a bilateral transpedicular or bilateral extra-pedicular approach. We describe performance of balloon kyphoplasty using a unilateral, single, balloon tamp via a unilateral transpedicular approach. The advantages of a unilateral approach are reducing the risk, albeit low, of pedicle fracture, medial transgression of the pedicle and/or transgression into the spinal canal, nerve injury, cement extravasation along the cannula tract, and spinal epidural hematoma. Additionally, operative and anesthesia time is reduced, as well as the costs of balloon tamps, cannulas, and needles.
An 83-year-old woman with osteoporosis presented with severe lower thoracic back pain which occurred when she bent over to lift a heavy box. The pain was reproducible on palpation of the T-11 spinous process. A spine MRI with STIR (short tau inversion recovery) sequence demonstrated a subacute T-11 vertebral body compression fracture with associated edema. A T-11 balloon kyphoplasty was performed using a unilateral inflatable balloon tamp via a unilateral transpedicular approach. The patient reported immediate relief of pain and improvement of visual analog score (VAS) for pain from preoperative 10 to postoperative 2. She was able to ambulate postoperatively whereas preoperatively she was inhibited by pain.
Balloon kyphoplasty can be performed using a unilateral balloon tamp via a unilateral pedicular approach. The key is a medial needle trajectory with a final balloon position in the midline of the vertebral body.
经皮球囊椎体后凸成形术与经皮椎体成形术一样，是治疗骨质疏松性椎体压缩性骨折疼痛的一种治疗干预措施。该手术包括通过双侧椎弓根或双侧椎弓根外入路在骨折椎体中放置双侧可充气球囊填塞器。我们描述了通过单侧椎弓根入路使用单侧单个球囊填塞器进行球囊椎体后凸成形术的操作。单侧入路的优点是降低了椎弓根骨折、椎弓根内侧穿破和/或穿入椎管、神经损伤、骨水泥沿套管通道渗漏以及脊髓硬膜外血肿的风险，尽管这些风险较低。此外，手术和麻醉时间缩短，球囊填塞器、套管和穿刺针的成本也降低。
一名83岁的骨质疏松女性患者，在弯腰搬一个重箱子时出现严重的下胸背部疼痛。触诊T-11棘突时可再现疼痛。脊柱MRI的短T1反转恢复（STIR）序列显示T-11椎体亚急性压缩性骨折并伴有水肿。通过单侧椎弓根入路使用单侧可充气球囊填塞器进行了T-11球囊椎体后凸成形术。患者报告疼痛立即缓解，疼痛视觉模拟评分（VAS）从术前的10分改善至术后的2分。术后她能够行走，而术前她因疼痛而行动受限。
球囊椎体后凸成形术可通过单侧椎弓根入路使用单侧球囊填塞器进行。关键是采用内侧进针轨迹，使最终球囊位于椎体中线位置。
