Tartara Fulvio, Armocida Daniele, Garbossa Diego, Meli Francesco, Costantino Gabriele, Cofano Fabio, Francaviglia Natale
Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Front Surg. 2023 May 3;10:1152995. doi: 10.3389/fsurg.2023.1152995. eCollection 2023.
Vertebral augmentation procedures (VAPs) are used in cases of persistent and unresponsive pain in patients with vertebral compression fractures (VCFs). Although VAPs are considered a safe procedure providing quick pain relief and improved physical function, some postoperative complications can occur, for example, bone cement leakage. The material used in this procedure is almost exclusively polymethyl methacrylate (PMMA), which appears to lack biological activity and osteointegration capabilities. In this study, we introduce a new filling system consisting of cannulas preloaded with titanium microspheres, which stabilizes and consolidates the structure of the vertebral body in treating VCFs after the performance of the kyphoplasty procedure.
We report a retrospective case series of six patients affected by osteoporotic vertebral fractures with worsening back pain, neurologic impairment, and failed conservative treatment who underwent the VAP at our institute, for which the SPHEROPLAST [MT ORTHO s.r.l., Aci Sant'Antonio (CT), Italy] system was used.
The patients had failed an average conservative trial of 3.9 weeks before they presented to us with neurodeficit. There were two men and four women with a mean age of 74.5 years. The average hospital stay was 2 days. There were no reported perioperative complications related to cement injection, such as intraoperative hypoxia, hypotension, pulmonary embolization, myocardial infarction, neurovascular or viscera injury, or death. The VAS score significantly decreased from a mean preoperative of 7.5 (range 6-19) to 3.8 (range 3-5) immediately after surgery and 1.8 (range 1-3).
We report the first clinical results in a series of six patients treated for VCF using the microsphere system after analyzing the clinical results produced by, and the complications that arose from, this new device. In patients with VCF, the VAP using titanium microspheres appears to be a feasible and safe procedure with a low risk of material leakage.
椎体强化手术（VAPs）用于治疗椎体压缩骨折（VCFs）患者持续且难治性疼痛的情况。尽管VAPs被认为是一种安全的手术，能快速缓解疼痛并改善身体功能，但仍可能发生一些术后并发症，例如骨水泥渗漏。该手术几乎仅使用聚甲基丙烯酸甲酯（PMMA）材料，这种材料似乎缺乏生物活性和骨整合能力。在本研究中，我们介绍一种新的填充系统，该系统由预装钛微球的套管组成，在椎体后凸成形术后治疗VCFs时能稳定并巩固椎体结构。
我们报告了一组回顾性病例系列，6例患有骨质疏松性椎体骨折且背痛加重、神经功能受损且保守治疗失败的患者在我们研究所接受了VAP，手术使用了SPHEROPLAST [MT ORTHO s.r.l., 意大利阿西圣安东尼奥（CT）] 系统。
患者在出现神经功能缺损前来找我们之前，平均保守治疗失败了3.9周。其中男性2例，女性4例，平均年龄74.5岁。平均住院时间为2天。未报告与骨水泥注射相关的围手术期并发症，如术中缺氧、低血压、肺栓塞、心肌梗死、神经血管或内脏损伤或死亡。视觉模拟评分（VAS）从术前平均7.5（范围6 - 19）显著降至术后即刻的3.8（范围3 - 5）以及1.8（范围1 - 3）。
在分析了这种新装置产生的临床结果和出现的并发症后，我们报告了使用微球系统治疗VCFs的6例患者系列的首批临床结果。在VCF患者中，使用钛微球的VAP似乎是一种可行且安全的手术，材料渗漏风险低。
