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Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures

STUDY DESIGN: Retrospective case series observational study. PURPOSE: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. O...

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Autores principales: Afathi, Mehdi, Mansouri, Nacer, Farah, Kaissar, Benichoux, Victor, Blondel, Benjamin, Fuentes, Stéphane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454290/
https://www.ncbi.nlm.nih.gov/pubmed/30481979
http://dx.doi.org/10.31616/asj.2018.0129
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author Afathi, Mehdi
Mansouri, Nacer
Farah, Kaissar
Benichoux, Victor
Blondel, Benjamin
Fuentes, Stéphane
author_facet Afathi, Mehdi
Mansouri, Nacer
Farah, Kaissar
Benichoux, Victor
Blondel, Benjamin
Fuentes, Stéphane
author_sort Afathi, Mehdi
collection PubMed
description STUDY DESIGN: Retrospective case series observational study. PURPOSE: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE: Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS: We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population’s mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck’s Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS: Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck’s Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS: Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients.
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spelling pubmed-64542902019-04-19 Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures Afathi, Mehdi Mansouri, Nacer Farah, Kaissar Benichoux, Victor Blondel, Benjamin Fuentes, Stéphane Asian Spine J Clinical Study STUDY DESIGN: Retrospective case series observational study. PURPOSE: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE: Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS: We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population’s mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck’s Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS: Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck’s Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS: Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients. Korean Society of Spine Surgery 2019-04 2018-11-29 /pmc/articles/PMC6454290/ /pubmed/30481979 http://dx.doi.org/10.31616/asj.2018.0129 Text en Copyright © 2019 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Afathi, Mehdi
Mansouri, Nacer
Farah, Kaissar
Benichoux, Victor
Blondel, Benjamin
Fuentes, Stéphane
Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title_full Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title_fullStr Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title_full_unstemmed Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title_short Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures
title_sort use of cement-augmented percutaneous pedicular screws in the management of multifocal tumoral spinal fractures
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454290/
https://www.ncbi.nlm.nih.gov/pubmed/30481979
http://dx.doi.org/10.31616/asj.2018.0129
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