Telera Stefano, Pompili Alfredo, Crispo Francesco, Giovannetti Maddalena, Pace Andrea, Villani Veronica, Fabi Alessandra, Sperduti Isabella, Raus Laura
Department of Neurosurgery, IRCSS National Cancer Institute "Regina Elena", Rome, Italy.
Department of Neurosurgery, IRCSS National Cancer Institute "Regina Elena", Rome, Italy.
Clin Neurol Neurosurg. 2018 Aug;171:184-189. doi: 10.1016/j.clineuro.2018.06.018. Epub 2018 Jun 15.
Balloon Kyphoplasty (BKP) for vertebral compression fractures (VCFs) in cancer patients is more challenging than for osteoporotic ones. Cord compressions are frequent and the incidence of complications ten-fold greater. Polymethylmetacrylate (PMMA) is the gold standard material for BKP but has disadvantages: exothermic reaction, short working time, rapid solidification, absence of osteoconduction. VK100 is a mixture of Dimethyl Methylvinyl siloxane and Barium Sulphate. It is elastic, adhesive to bone, leaves 30 min before solidification without exothermic reaction, and shows a stiffness close to the intact vertebrae. The surgical procedure, called elastoplasty, is similar to a BKP. Clinical results obtained with this new silicone in pathological VCFs have been investigated.
41 cancer patients with symptomatic VCFs (70 vertebral bodies), underwent percutaneous and open elastoplasties. Post-operative leakages, pulmonary embolism (PE) and adjacent fractures were carefully evaluated with neuroimaging. KPS, VAS and Dennis Pain Score were calculated pre- post-operatively and at the last follow-up.
The mean volume of silicone inserted in each vertebra was 3.8 cc. Complications included seven leakages (17%), two asymptomatic PE (4.3%) and 3 post-operative adjacent fractures (7.3%). Median follow-up was 29 months. A significant improvement was observed in KPS, VAS and Dennis Pain Score (p < .0001). The 1-yr survival rate was 76.9%.
Elastoplasty appears a safe and effective palliative treatment of VCFs in oncologic patients. Useful qualities of VK100 are the lack of exothermic reaction and the wider working window. The influence of biomechanical properties of silicone on reduction of adjacent level fractures requires further investigations.
癌症患者椎体压缩性骨折（VCF）的球囊椎体后凸成形术（BKP）比骨质疏松性骨折患者更具挑战性。脊髓压迫频繁，并发症发生率高出十倍。聚甲基丙烯酸甲酯（PMMA）是BKP的金标准材料，但有缺点：放热反应、工作时间短、快速固化、无骨传导性。VK100是二甲基甲基乙烯基硅氧烷和硫酸钡的混合物。它具有弹性，与骨粘连，固化前有30分钟时间且无放热反应，其硬度接近完整椎体。这种手术方法称为弹性成形术，类似于BKP。已对这种新型硅酮在病理性VCF中的临床效果进行了研究。
41例有症状VCF的癌症患者（70个椎体）接受了经皮和开放性弹性成形术。术后渗漏、肺栓塞（PE）和相邻椎体骨折通过神经影像学进行仔细评估。术前、术后及最后一次随访时计算KPS、VAS和丹尼斯疼痛评分。
每个椎体注入硅酮的平均体积为3.8 cc。并发症包括7例渗漏（17%）、2例无症状PE（4.3%）和3例术后相邻椎体骨折（7.3%）。中位随访时间为29个月。KPS、VAS和丹尼斯疼痛评分有显著改善（p<0.0001）。1年生存率为76.9%。
弹性成形术似乎是肿瘤患者VCF的一种安全有效的姑息治疗方法。VK100的有用特性是无放热反应和更宽的工作窗口。硅酮生物力学特性对减少相邻节段骨折的影响需要进一步研究。
