흉추에서의 경척추경 접근법을 통한 경피적 척추체성형술 및 척추체 후만변형 복원술에 관한 후향성 연구

Retrograde Study on Thoracic Percutaneous Vertebroplasty and Kyphoplasty Done by Transpedicular Approach

  • 조주연 (서울대학교 의과대학 마취통증의학교실) ;
  • 배영곤 (서울대학교 의과대학 마취통증의학교실) ;
  • 김양현 (서울대학교 의과대학 마취통증의학교실) ;
  • 이은형 (서울대학교 의과대학 마취통증의학교실) ;
  • 이철중 (서울대학교 의과대학 마취통증의학교실) ;
  • 이상철 (서울대학교 의과대학 마취통증의학교실) ;
  • 김용락 (서울대학교 의과대학 마취통증의학교실)
  • Joh, Ju Yeon (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Bae, Young Gon (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Kim, Yang Hyun (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Eun Hyung (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Chul Joong (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Sang Chul (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Kim, Yongn Lak (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine)
  • 투고 : 2005.09.20
  • 심사 : 2005.12.14
  • 발행 : 2005.12.10

초록

Background: Transpedicular percutaneous vertebroplasty, along with kyphoplasty of the thoracic vertebrae, is technically more difficult than those of the lumbar vertebrae due to the anatomical differences. During the last four years, all the percutaneous vertebroplasty and kyphoplasty of the thoracic vertebrae carried out at our institution were performed using a transpedicular approach; therefore, we tried to find if there were any problems or complications associated with the process. Methods: The medical records of all the patients who had undergone thoracic percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. The following were looked up: the procedure name, unipedicular or bipedicular, the level of the thoracic vertebrae treated, and the pre- and postoperative changes in the Visual Analog Scales (VAS), the volume of cement injected and complications. Results: In the last four years, 58 vertebral bodies in 58 patients were treated. Twelve and 46 vertebral bodies were treated by kyphoplasty and vertebroplasty, respectively. A total of 58 mid and lower thoracic levels were treated: T5 (n=1), T6 (n=1), T7 (n=3), T8 (n=4), T9 (n=1), T10 (n=4), T11 (n=14) and T12 (n=30). The mean preoperative and postoperative VAS scores were $8.1{\pm}1.4$ and $5.2{\pm}1.7$, respectively. The mean volume of cement injected was $4.01{\pm}1.85ml$; $3.18{\pm}0.60ml$ at T5-8 and $4.22{\pm}2.27ml$ at T9-12. There were no clinical complications, such as pedicular fracture or cement leakage. Conclusions: Although transpedicular vertebroplasty and kyphoplasty at the mid to lower thoracic vertebral bodies is technically difficult compared to that at the lumbar region, the procedures can be performed safely.

키워드

참고문헌

  1. Barr JO, Barr MS, Lemley TJ, McCann RM: Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000; 25: 923-8.
  2. Mathis JM, Wong W: Percutaneous vertebroplasty: technical considerations. J Vasc Interv Radiol 2003; 14: 953-60.
  3. Mathis JM, Barr JO, Belkoff SM, Barr MS, Jensen ME, Oeramond H: Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures, A]NR Am J Neuroradiol 2001; 22: 373-81.
  4. Chiras J, Oepriester C, Weill A, Sola-Martinez MT, Oeramond H: Percutaneous vertebral surgery. Techniques and indications, J Neuroradiol 1997; 24: 45-59.
  5. Kallmes OF, Jensen ME: Percutaneous vertebroplasty, Radiology 2003; 229: 27-36.
  6. Hedlund LR, Gallagher JC, Meeger C, Stoner S: Change in vertebral shape in spinal osteoporosis. Calcif Tissue Int 1989; 44: 168-72,
  7. Amar AP, Larsen OW, Esnaashari N, Albuquerque FC, Lavine SD, Teitelbaum GP: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 2001; 49: 1105-14.
  8. Kallmes DF, Schweickert PA, Marx WF, Jensen ME: Vertebroplasty in the mid- and upper thoracic spine. Am J Neuroradiol 2002; 23:1117-20.
  9. Park CK, Kim DH, Ryu KS, Son BC: Therapeuric effecrs of kyphoplasty on osteoporotic vertebral fractures. J Korean Neurosurg 2005; 37: 116-23.
  10. Corter B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al: Percuraneous vertebroplasty in the treatment of osreoporotic vertebral compression fractures: an open prospeerive study. J Rheumarol 1999; 26: 2222-8.
  11. Parkinson RJ, Bendok BR, O'Shaughnessy BA, Tella M, Ondra SL, Walker MT, et al: Percutaneous kyphoplasty. Contemporary Neurosurgery 2005; 27: 1-6.
  12. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR: Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fraerures Research Group. Arch Intern Med 1999; 159: 1215-20.
  13. Lieberman IH, Dudeney S, Reinhardt MK, Bell G: Initial outcome and efficacy of 'kyphoplasty' in the treatment of painful osteoporotic vertebral compression fractures. Spine 2001; 26: 1631-8. https://doi.org/10.1097/00007632-200107150-00026
  14. Shin KM: A new method of approach for percutaneous thoracic vertebroplasty in vertebral compression fracture. Korean J Pain 2000; 13: 237-41.