Percutaneous Vertebroplasty In The Treatment Of Upper-Thoracis Vertebral Fractures

Objective To discuss the the feasibility, safety and efficacy of percutaneous vertebroplasty(PVP) in the treatment of upper-thoracic spine (from T1 to T4) vertebral compression fractures(VCFS).Method 20 patients with painful thoracic vertebra VCFS,a total of 25 vertebrae are treated by PVP under unilateral extrapedicular approach.The patients included 5 males and 15 females,with average of 57-89 years (71.0±10.8).The fractures are located at Tl(n= 2), T2(n= 3), T3(n= 5), T4(n=15).Vein and local anesthesia,The patient is positioned prone on operation table.Fluoroscopic guidance is used for the puncture process. There are three positions for the Patient in order to allow good visualisation up to upper-thoracic spine.Position one(n=2):The arms remain adducted and shoulders are pulled down. Position two(n=21):Raising the shoulders. Position three(n=2):"freestyleswimming" position.Recording the time of procedure and the volume of polymethylmethacrylate(PMMA) for each vertebral body.At the time of post-procedure and follow-up review of X ray film and CT to understand distribution of bone cement.Comparing the VAS of back pain、mobility score、ODI at preoperative and 3 days of post-procedure and the final follow-up.Result The procedure was successfully accomplished in all patients.The mean procedure time is 39.74±10.6mins (25-55mins) for 20 cases undergoing unilateral extrapedicular approach.The mean blood loss was 6.3±2.9ml.The average volume of polymethylmethacrylate(PMMA) injected into each vertebral body is 2.0-6.0ml (3.3±1.5ml).18 patients are followed up,with the value of 5.5-18months(7.63±2.72months).The cement leakage observed on radiograph rate was 15%, included slight leakage to the epidural(n=1,5%),paravertebral soft tissues(n=1,5%),disc(n=1,5%),but they were asymptomatic and free of intervention.One case (n=1,5%) occurred new fracture within 15 days,not in the adjacent level and diseased vertebrae, which were underwent PVP. During the rest of follow up,new fracture either in diseased level or adjacent level could be found.No other serous complications such as rib fracture,pneumothorax,pulmonary embolism, vascular injury,spinal injury,infection was found.The preoperative VAS is 7.35±0.74; mobility scores is 2.95±0.95;ODI (%) is 80.45±2.76。At the 3 days postoperative,1 month post-procedure,the final follow-up,the VAS are 2.40±0.68, 2.20±0.69,2.19±0.45,1.90±0.39.Mobility score are:1.95±0.76、1.72±0.75、 1.55±0.50、1.50±0.51.ODI are 40.50±3.76; 34.22±10.82; 32.20±5.97; 30.30±5.55.Compared with the preoperative,the value of VAS、mobility scores and ODI showed statistical significance at 3 days、1 month、3 months the follow up after the procedure(P<0.01).Conclusion PVP using unilateral extrapedicular approach for the treatment of upper-thoracic vertebral OVCF is a safe and effective procedure.And PVP is a significant value on pain relief with minimally feature.Due to the particularity of upper thoracic vertebral anatomic structure,the most important factors for successful vertebroplasty are the correct diverse position of the patient,a good view of the vertebral body under fluoroscopy and an accurate puncture approach and technology during the procedure.The surgical techniques of PVP in our study can provide a reference for future clinical practice.