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Advanced Vertebral Augmentation Treatments including Pedicle and Recurrent Fractures 2012

Interventional Spine

Mario, Muto
G, Guarnieri, Non ASSR Member

Paper/Non-Mentor

Purpose

Vertebroplasty (VP) and Kyphoplasty (KP) are well established percutaneous minimally invasive technique for the treatment of vertebral body fractures (VCF). The main therapeutic indications of VP and KP are represented by: 1) vertebral collapses of osteoporotic nature; 2) multiple myeloma or metastatic vertebral neoplasm; 3) symptomatic or aggressive vertebral haemangioma 4) traumatic fracture The rationale for this technique is based on the principle which the injection of PMMA in the collapsed soma stabilizes the movements of the trabecular and spongiosal microfractures (responsible for the pain) making more compact and resistant the vertebral body, with a consequent antalgic effect. Even if the safety and the efficacy of those techniques are well-established by several studies and trials.[1-5] Few procedural disadvantages or limits for each technique are present: - venous and disk leakage with risk of pulmonary emboli - the risk of new vertebral fracture at adjacent or distant metamer after the first VP or KP treatment (related to porotic disease) the incomplete fracture reduction. The aim of this paper is to show the new devices created to reduce those limits improving the vertebral augmentation technique.

Results

New Devices The rational of useful new devices is: 1. to increase vertebral height restoration compared to VP 2. to reduce the significant loss of the restored height especially after balloon deflation for Kyphoplasty prior to cement injection; 3. to reduce the disk and venous leakage with increase risk of new fracture to adjacent metamer The risk of new vertebral fracture to distant or adjacent metamer after the first cementoplasty remains still controversial as a technical limit. It is well known that for all patients with a first osteoporotic vertebral collapse it exists a risk of developing new fractures in the following year of about 19.2%[7] and patients with a porotic collapse, treated with VP or KP, are demonstrated to have a risk of vertebral refracture adjacent or distant from the site of the treatment that varies from 10 to 30%.[6-13]. Even if the risk of news VCFs is caused by natural evolution of the osteoporosis disease, vertebral cementoplasty could therically modifies the spinal biomechanics causing new VCFs, especially at adjacent metamers. The significant loss of the restored vertebral height after balloon deflation prior to cement injection is a common condition that frequently appears during KP. Vertebral body stenting (VBS) by Synthes® is a new device of implantation of endovertebral stent for vertebral augmentation as an alternative to "conventional" cementoplasty with the aim to implant a metallic scaffold before PMMA injection combining the antalgic effect of PMMA injection, like VP, with the vertebral augmentation thanks to expanding double stents into vertebral body.[14-16] Indication for VBS includes - poroticVCFs from T7 - L5 , without involvement of the posterior vertebral edge with kyphotic angulation of more than 15°, and in combination with internal fixation - Acute traumatic fracture Magerl A1 type within 2 weeks from the trauma - Selected cases of A2-A3 traumatic fractures related to age and comorbities within 2 weeks from the trauma The treatment consists of restoring the normal alignment of the spine by improving the normal biomechanics of the spine and reducing the pain and the risk of new vertebral compression fracture at adjacent level. The stents into vertebral body, in fact permit to have a significantly decrease of the height loss after balloon deflations by using VBS compared to kyphoplasty, thus offering a new promising option for vertebral augmentation. [15]Fig.1a-c The Kiva VCF Treatment System consists of a single-use deployment system with the Kiva Coil and the Kiva Implant. The first one creates an internal scaffold designed to reduce the fracture and maintain the restored height of the vertebral body using a material mechanically similar to natural bone, thereby offering the potential to reduce adjacent level fractures. The Kiva Implant is designed to facilitate cement direction and containment, reduce the risk of extravasation, decrease the amount of bone cement required to stabilize the fracture with less extravasation, Endplate-to-endplate Support, by unipedicular The OsseoFix Spinal Fracture Reduction System allows for precise implant placement and deployment delivering controlled. It means as a scaffold to facilitate the stabilization and reduction of spinal fractures creating a bony. The system can be placed at T6-L5 level, not at cervical level anymore with or without OsseoFix+ Bone Cement, a radiopaque Bone Cement iSelf-hardening, ready to use, medium-viscosity with a high percentage of radiopaque agent (45%) for maximum visibility during VP. KyphX® Expressâ