zouboulis augmentation
TRANSCRIPT
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Vertebral augmentation
Assistant Professor, Department of Orthopaedics,
Patras University, GREECE
Olympion Hospital and Rehabilitation Center, Patras
Elected President, Spine Division, Greek Orthopaedic
Society for year 2011 Interest:
MIS, Aging spine
Rehabilitation
Medical education, training and evaluating MIS
techniques
Enjoys Basketball, Gym, Travel, Social Networking
Contact: [email protected] E. Zouboulis,
MD, PhD
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Vertebral augmentation
Panayotis E. ZouboulisAssistant Professor Orthopaedics
University of Patras
GREECE
Disclosure:
consultant, stockholderAlphatec Spine
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A review of complications associated with vertebroplasty
and kyphoplasty as reported to the Food and Drug Administration
medical device related web site.
Nussbaum DA et al, J Vasc Interv Radiol 2004
Literature review
PMMA hypotension
embolic disease death (> 3 levels)
cement leakage (neurologic complications greater vessels?)
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Literature review (c ed)
Garfin SA et al, Spine 2001
overall risk
0.7% per level
1.2% per patient
0
10
20
30
40
50
60
primary osteoporosis secondary osteoporosis trauma tumor
2002 2008 balloon kyphoplasty
101 pts 200 levels
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Fribourg D et al, Spine 2004
...subsequent adjacent fractures, especially during
the first 2 months after the index procedure.
Villarraga ML et al, J Spinal Disord Tech 2005
may be related to the underlying etiology (weakening of the bone)
rather than the surgical intervention.
3m p.op.
Adjacent level fracture
Literature review (c ed)
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Monticelli F et al, Forensic Sci Int 2005
Zaccheo MV et al, Am J Emerg Med 2008
Kao FC et al, Spine 2008
Lim KJ et al, Anesth Analg 2007
Pulmonary embolism
Mortality rate 0.4%CT-guided vertebroplasty: analysis of technical results,
extraosseous cement leakages and complications in 500 cases.
Pitton MB et al, Eur Radiol 2008
Balloon kyphoplasty and vertebroplasty for VCF:
a comparative systematic review of efficacy and safety.
Taylor RS et al, Spine 2006
Literature review (c ed)
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internal brace
Implant expandable device
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Star shaped
interdigitationBone captured within
implant
Cement
extruding from
implant andgrabbing
bone
Tip of implant
Observations
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-0,45
-0,40
-0,35
-0,30
-0,25
-0,20
-0,15
-0,10
-0,05
0,00
HeightLoss(
cm)
Collapse of Repaired Vertebral Bodies Following Testing
Kyphoplasty
Implant
p
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Biomechanical data
0
0,5
1
1,5
2
2,5
3
3,5
Volume(mL)
Cement Injection Volume
Implant
Kyphoplastyp
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Osteoporosis
P.G. female, 72y
4m p.op.
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Secondary osteoporosis
Stenosis - kyphotic deformity
1y p.op.
G.L. female, 75y
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Acute trauma
S.N. male, 38y
p.op.
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Acute trauma
Z.D. male, 52y
6m p.op.
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p.op.
Ca uterus
L.M. female, 58y
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Ca prostate
CML
1,5y p.op.
P.A. male, 71y
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Ca colon
H.G. female, 84y
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Results
46 patients, 111 levelsmean age 66,4 y
1y p.op.
VAS 51mm ODI 25.1
height restoration 9% (7% last follow up)
kyphotic angle 3.7 (2.9 last follow up)
6 adjacent level fractures
No pulmonary embolism
No severe cement leakage
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Conclusions
Improved clinical results
Well tolerated by respiratory restricted patients
Expanded indications
acute trauma (stand-alone device?)osteolytic lesions
combined open/MIS procedures
Adjacent level fractures?