변형된 일측성 척추경 골성형술

초록

Objectives: The authors have applied the percutanous vertebroplasty with a modified unilateral transpedicular instead of the conventional bilateral transpedicular approach to the osteoporotic compression fracture patients. Their clinical and radiological outcomes were analysed. Methods: The 25 injections of 18 patients of unilateral transpedicular percutanous vertebroplasty between January and June 2002 were performed. The target of needle in the unilateral transpedicular approach differ from bilateral transpedicular approach. In the lumbar region, the AP fluoroscopy tube is angled more laterally until the oval appearance of the pedicle is transformed into a "Scotty dog" appearance over the pedicle. In the thoracic regions, we empirically angle the tube to approximately 20°. The needle is advanced until it approaches the anterolateral wall of the contralateral half of the vertebra. The methods of cement mix and deposition is the same as the conventional bipediculate approach. However, total amounts of injected cement was 2-3cc. Plain radiographs and CT on the injection site after procedure was obtaind to confirm the location of injected bone cement. Clinical and raidiological results before/ after procedure were compared with. Results: Mean age was was 72.33 years. The managed verteral consisted of 8 at thoracic, 10 at lumbar and 7 at combined level. The filling across the midline was achieved in 22 of 25 injections. The epidural leakage was not observed in all patients. 15(83%) of 18 patients achieved adequate pain relief with mean improvement of functional outcome. Conclusion: The unilateral transpedicular approach have the advantage of the good midline filling of cement, the short procedure time, less chance of epidural leakage in addition to pain relief of osteoporotic compressioin fracture patients.