Tallahassee Orthopedic Clinic, Tallahassee, FL; Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL.
Tallahassee Orthopedic Clinic, Tallahassee, FL.
Pain Physician. 2019 Mar;22(2):177-185.
Vertebral compression fractures (VCFs) can be conservatively treated with pain management, bracing, and bed rest, or treated surgically with a kyphoplasty or vertebroplasty procedure.
The objective of this retrospective review was to assess the viability, safety, and efficacy of using local anesthesia with oral sedation for an office-based kyphoplasty procedure.
A retrospective review.
Private orthopedic clinic.
Ninety-nine consecutive patients (9 office-based and 90 ambulatory surgical centers [ASC]) between January 2015 to May 2017 receiving their first percutaneous balloon kyphoplasty (PBK) with our physician in an office-based setting or at an ASC. Clinical outcomes observed were rates of surgical complications, 6-month re-fracture rates, adjacent fracture rates, and postprocedure medical management.
No intraoperative complications were observed during the PBK procedure. No re-fractures occurred during the 6-month follow-up window. A total of 6% of the patients experienced an adjacent vertebral compression fracture, but there were no significant differences between facility type. Level-specific verbal pain score at the postoperative follow-up visit was significantly lower than at the preoperative visit for the cohort (5.3 ± 3.1 vs.7.5 ± 2.0) (P = 0.001) and the ASC group (5.5 ± 3.1 vs. 7.5 ± 2.0) (P = 0.002).
Only 9 single-level office-based PBKs were performed by a single physician andfollowed for at least 6 months suggesting these findings cannot be generalized to all patients, practitioners, facilities, or vertebral augmentation procedures (VAPs).
To the best of our knowledge, this study of a continuous series of primary PBKs was the first to report the safety of an office-based procedure. The cohort reported significantly lower pain at their first postoperative follow-up visit when compared to their preoperative visit, adding to the body of evidence that PBKs are an effective treatment for pain associated with VCFs. The overall adjacent fracture rate in this series (6%) was slightly lower than previously reported for VAPs performed in a hospital under local anesthesia (7%-13%).
Osteoporosis, vertebral compression fracture, kyphoplasty, local anesthesia, office- based, oral sedation.
椎体压缩性骨折（VCFs）可采用疼痛管理、支具和卧床休息进行保守治疗，也可采用后凸成形术或椎体成形术进行手术治疗。
本回顾性研究的目的是评估在局麻加口服镇静下进行门诊后凸成形术的可行性、安全性和疗效。
回顾性研究。
私人骨科诊所。
2015 年 1 月至 2017 年 5 月期间，99 例连续患者（9 例门诊和 90 例日间手术中心 [ASC]）在我们的医生的办公室环境或 ASC 接受了他们的第一次经皮球囊后凸成形术（PBK）。观察到的临床结果包括手术并发症发生率、6 个月再骨折率、相邻骨折率和术后医疗管理。
在 PBK 手术过程中未观察到术中并发症。在 6 个月的随访期间没有发生再骨折。共有 6%的患者发生相邻椎体压缩性骨折，但在设施类型之间没有显著差异。术后随访时，与术前相比，队列的特定节段性口头疼痛评分显著降低（5.3±3.1 对 7.5±2.0）（P=0.001）和 ASC 组（5.3±3.1 对 7.5±2.0）（P=0.002）。
只有 9 例单节段门诊 PBK 由一名医生进行，随访至少 6 个月，这表明这些发现不能推广到所有患者、医生、设施或椎体强化术（VAPs）。
据我们所知，这项原发性 PBK 的连续系列研究首次报告了门诊手术的安全性。与术前相比，该队列在首次术后随访时疼痛明显减轻，这进一步证明了 PBK 是治疗 VCF 相关疼痛的有效方法。在本系列中，总体相邻骨折率（6%）略低于先前报道的在局麻下于医院进行的 VAPs（7%-13%）。
骨质疏松症，椎体压缩性骨折，后凸成形术，局麻，门诊，口服镇静。
