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KMID : 1141120180040020042
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The Nerve
2018 Volume.4 No. 2 p.42 ~ p.49
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Double Sequential Ballooning (Eggshell) Method for Treatment of Severe Metastatic Compression Fractures with Extra-Compartment Involvement: In Comparison with Conventional Balloon Kyphoplasty
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Lee Jong-Seok
Gwak Ho-Shin
Lee Sang-Hyun
Joo Jung-Nam
Kwon Ji-Woong
Yoo Heon-Yoo
Shin Sang-Hoon
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Abstract
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Objective: Severely compressed vertebral fractures with extra-compartment involvement are considered relative contraindications for percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) in the fear of cement leakage or failure in vertebral height restoration. The purpose of the current study was to evaluate the effectiveness of a new technique known as double sequential ballooning (eggshell) method for severe metastatic compression fractures (MCFs) with extra-compartment involvement.
Method: We retrospectively reviewed 118 patients with MCF who underwent BKP between March 2002 and September 2017. Among them, 9 patients underwent BKP using the eggshell method. We analyzed the differences of radiological and clinical results between these 2 patients groups.
Results: Patients who underwent BKP using the eggshell method showed a higher frequency of severe compression (p=0.026), and more columns involvement as per 6-column classification (p=0.004) compared with those who underwent conventional BKP. They also showed higher frequency of paravertebral (PV) extension and PV and epidural involvement (p<0.001). The median amount of injected cement was significantly higher in eggshell group compared with conventional BKP (7.5 cc vs. 6 cc; p=0.049), and so, vertebral body (VB) height gain was (4mm[range. 2-9mm] vs. 2.5mm[range, 0-10mm]; p=0.021). Patients in the eggshell group showed a lower rate of cement leakage, but the difference was statistically insignificant (p=0.273).
Conclusion: The eggshell method enabled injection of cement and restoration of vertebral height in patients with severe MCFs with extra-compartment involvement in comparison with conventional BKP. It is expected to reduce cement leakage in these patients.
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KEYWORD
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Fractures, compression, Kyphoplasty, Spinal fractures, Spine
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