الفهرس 
Contents
Indications and contraindications of PVP and PKPOnly 14 pages are availabe for public view
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Abstract
Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) provide pain relief and mechanical stabilization within a vertebral body to prevent further vertebral body collapse and achieve better functional results, help restoration of daily activities, and improvement of the psychological status of the patients. They also cause reduction the dose of analgesics when needed by some patients.
Both are simple day care procedures that can be performed under general or local anesthesia with IV sedation. They have a rapid effect in decreasing back pain when performed for the appropriate indications. They require a small number of instruments, C-arm image intensifier, in addition to bone cement.
Complications associated with bone cement injection are infrequent and mostly minor. They include extra-vertebral cement leakage which may lead, if voluminous, to myelopathy, radiculopathy or systemic cardiovascular or respiratory affection.
In our study, PVP and PKP were performed on 25 patients (13 PVP cases and 12 PKP cases) who suffered from painful spine as a result of OVCFs.
This pathological entity was more common among females than males notably the age above 60 years.
OVCFS commonly affect single level (24 out of 25 patients) and one anatomical compartment (Lumbar in our study), but could be double level and two anatomical compartments (Thoracic and lumbar in our thesis).
The visual analogue scale (VAS) is a simple and productive one in appreciating the reduction of the terrible pain among these patients where the pre-operative score ranged between 5-10 in both groups, which changed post-operatively to be 0-3 in PVP cases and 0-4 in PKP cases pointing to dramatic pain improvements in both groups but was statistically insignificant mostly due to small patient sample.
The modified Oswestry disability index (ODI) which measures patient’s permanent functional disability was markedly reduced and pointed to the effectiveness of PVP and PKP procedures among OVCFs patients where it was 40-70 pre-operatively in both groups and reduced to 2-12 and 2-10 post-operatively among PVP and PKP patients respectively, but was insignificant statistically mostly due to small patients sample.
Regarding the restoration of normal curvature of the affected spinal segment nearly, in PVP group changed the kyphoyic angle pre-operatively from 7.9°-12.5° to 5.3°-6.8° post-operatively and also, in PKP group the kyphotic angle changed from 8°-12.5° to 5.6°-8.5°, however the change difference in both groups was statistically insignificant mostly due to small sample patients size.
Regarding the correction of the affected vertebral body height, in the PVP group, it was changed from 56%-68% pre-operatively to 71%-75% post-operatively, while in PKP group it was changed from 54.3%-76% pre-operatively to 77%-82% post-operatively. However, the change difference in both groups was statistically insignificant mostly due to small sample size.
The complications of cementoplasty include:
- Cement leakage: include: intra-discal and peri-vertebral leakage.
- Radiation exposure for surgeons and patients.
Cement leakage was well tolerated in all cases and was insignificant and doesn’t reflect any relationship between the amount of cement and the clinical outcomes.
Both techniques were done as an out-patient procedure; however, PKP is very costly relative to PVP.
Conclusion:
Although percutaneous vertebroplasty and kyphoplasty are effective minimally invasive procedures in reducing pain and improving the quality life in patients with OVCFs but it may lead to serious neurological complications. So, patient selection and careful technique are of utmost importance for the success of the procedure. Moreover, PVP and PKP lead to some restoration of the sagittal balance through variable degrees of vertebral height and kyphotic angle correction.
Furthermore, trials are needed to study the long term effects of PVP and PKP in treatment of OVCFs.