Evaluation à 1 an du Spine Jack X.Barreau

9H30 9H38 Evaluation à 1 an du Spine Jack X.Barreau

Transcript

1. Dr BARREAU X. Dr CURSOLLE Dr RENAUD C. Dr DURANDEAU E. Dr LUC S. PR VITAL JM Pr DOUSSET V UNIVERSITY HOSPITAL OF BORDEAUX - France Interventionnal Neuroradiology department Orthopedic Surgery department A NEW DEVICE FOR PERCUTANEOUS VERTEBRAL RE-EXPANSION. PRELIMINARY EXPERIENCE IN 23 PATIENTS FOR MAGERL TYPE A TRAUMATIC BURST FRACTURES
2. Treatment of non neurological thoracolumbar burst fracture remains controversial. Wood 2003 : Conservative treatment similar to surgery Delayed and painful kyphosis may happen up to 38 % of cases in some studies (Kohler in Eur Spin J 2008 )
3. Treatment of non neurological thoracolumbar burst fracture remains controversial. Wood 2003 : Conservative treatment similar to surgery Delayed and painful kyphosis may happen up to 38 % of cases in some studies (Kohler in Eur Spin J 2008 ) New techniques have been develloped to increase prognosis and to reduce bed rest time or bracing : Vertebroplasty - Huet 2004 - J of neuroradiology Balloon Kyphoplasty – Maestretti 2005 Europ spine J 2 years follow up.
4. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection
5. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection
6. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection
7. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection Exclusive cranio-caudal expansion,No lateral shear stress, Trabecular frame preservation. 20 mm Up to 15 mm
8. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection Exclusive cranio-caudal expansion,No lateral shear stress, Trabecular frame preservation. 20 mm Up to 15 mm
9. Percutaneous reduction of non surgical burst fracture using a permanent intravertebral Implant (SPINEJACK – Vexim SA- Toulouse – France) combined with cement injection Exclusive cranio-caudal expansion,No lateral shear stress, Trabecular frame preservation. 20 mm Up to 15 mm
10. 23 patients referred for acute spinal trauma at high energy All excluded from surgery because non neurological and stable fracture Suspected osteoporotic lesion excluded from that study X Ray - CT before treatment and at 6 months Geometric study of treated level Pain score (V.A.S.) at D0 – D 180 TREATMENT : General anaesthesia Between 45 and 90 minutes ( 2 levels) Before D 10 post trauma Evaluating endplate remodelling and fracture reduction Evaluating pain reduction Evaluating stability of treated vertebra at 6 month
11.  23 consecutives patients. 26 treated levels from T11 to L3.  3 procedures were double level reduction.  Type of fractures : 20 were A3-1 fracture 6 were A1
12. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
13. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
14. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
15. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
16. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
17. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
18. 0 5.0 10.0 15.0 20.0 25.0 Anterior Left Midline Anterior right Vertebral h Height res 0 5.0 10.0 15.0 20.0 25.0 Midline Left Midline center Midline right Vertebral he Height resto
26. Mean regional delayed kyphosis : 2° 11° 9° 0°
27. 0 2.50 5.00 7.50 10.00 PAIN SCORE Pre op 6 months 0.7 All patients could be sent back home within 5 days except one ( calcaneum fracture) Mean discharge time : 3,2 days 22/23 patients stand walk alone the day after treatment without significant pain. Only two patients had a brace 5,3
28. Result shows a significant remodeling of endplate which is stable at 6 months follow up. As kyphosis is usually observed during first 6 months we may assume that :
29. Clinical data suggest strong evidence of benefits for SPINEJACK procedure compared to orthopedic treatment or surgery concerning time of bed rest and time of discharge.
30. The concept of cranio-caudal expansion device SPINE-JACK may represent an alternative to conservative or some surgical treatment because this new technique :  Allows a true vertebral endplate remodeling which may lead to excellent long term stability  Dramatically reduces hospitalisation time  May replace bracing in many cases
31. The concept of cranio-caudal expansion device SPINE-JACK may represent an alternative to conservative or some surgical treatment because this new technique :  Allows a true vertebral endplate remodeling which may lead to excellent long term stability  Dramatically reduces hospitalisation time  May replace bracing in many cases