Cho, Sung-Min
(Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine)
,
Nam, Yong-Suk
(Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea)
,
Cho, Byung-Moon
(Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
,
Lee, Sang-Youl
(Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine)
,
Oh, Sae-Moon
(Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
,
Kim, Moon-Kyu
(Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine)
Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the p...
Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.
Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.
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가설 설정
Cadaveric dissection. A: Photceraph shows the left posterolateal view of the extraforaminal area of L3-4. B: Photogragh shows the anterior view of the left side of the L3 vertebra.
A: Photceraph shows the left posterolateal view of the extraforaminal area of L3-4. B: Photogragh shows the anterior view of the left side of the L3 vertebra. The lateral wall of the peiicle has no vascular structure (white circle).
The lateral wall of the peiicle has no vascular structure (white circle). C: Schematic discnption shows the safe entry zone of lateral pedicle area (gray colored area). SP: spinous process, TP: transverse process, SF: sperior articular process of L4, D: intervertebral disc, YL: Y-ligamentf LA: lumbar segmental artery, A: anastomotic branch, PM : poertomedial branch of lumbar artery, PL: post아.
제안 방법
The outcome data were obtained by VAS (visual analogue scale; ranged 0-10) before surgery immediately after surgery and then every 4 weeks. If symptom of patients were change between the latest score, patients were questioned about the detailed change and the moment of the change.
Therefore, clinicians should be aware of these differences to avoid complications. The purpose of the present study is to describe the methods and pitfells of this procedure based on the anatomy of the lumbar area and to analyze clinical outcomes and complications.
대상 데이터
Board of Hallym University C이lege of Medicine. The 55 consecutive patients (M: F=15:40) who underwent percutaneous extrapedicular unilateral kyphoplasty or vertebroplasty for painful osteoporotic vertebral compression fractures at the 74 lumbar levels between March 2006 and December 2009. All patients had persistent d쟎pain which did not respond 2 conservative treatment.
후속연구
We Med to confirm discrepancy of statistical difference in height restoration and the reduction of kyphotic angle between the lumbar and thoracic vertebra. Further study with a larger sample and a longer term follow-up are needed to confirm our results.
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