Gerszten Peter C, Welch William C
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurosurg Spine. 2007 Jan;6(1):92-5. doi: 10.3171/spi.2007.6.1.92.
Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.
经皮球囊椎体后凸成形术已成为因病理性压缩骨折而疼痛的患者广泛采用的治疗选择。该手术的一个潜在风险是在放置聚甲基丙烯酸甲酯（PMMA）之前球囊膨胀过程中肿瘤移位至椎管并导致脊髓或马尾神经损伤。此外，PMMA与骨折皮质骨之间残留的任何肿瘤都可能导致稳定效果欠佳以及后续疼痛缓解不明显。作者描述了一种在椎体后凸成形术球囊膨胀和强化之前通过经皮工作通道从椎体内（VB）清除肿瘤的技术。该技术在所有三名出现疼痛的患者中均成功使用，且三例患者的疼痛均有所改善。在任何情况下均未出现PMMA渗入椎管的情况。联合椎体肿瘤减容和椎体后凸成形术技术能够改善PMMA在患病椎体内的放置，可能提高这些骨折稳定的安全性及临床有效性。
