Percutaneus vertebral augmentation assisted by peek implant in painful osteolytic

Transcript

1. 5eme Journee Scientifique
 ACTUALITES EN VERTEBROPLASTIE & EXPANSION VERTEBRALE VENDREDI 1er Février 2013 Espace SAINT-MARTIN PARIS
2. PERCUTANEOUS VERTEBRAL AUGMENTATION ASSISTED BY PEEK IMPLANT IN PAINFUL OSTEOLYTIC METASTASIS INVOL VING THE VERTEBRAL WALL: EXPERIENCE ON 40 PATIENTS G.C. Anselmetti Villa Maria Hospital Turin, ITALY
3. PURPOSE To assess feasibility, effectiveness and leakage rate reduction achieved by peek implant assisted vertebroplasty (Kiva-Benvenue Medical) in osteolytic metastases with vertebral wall involvement
4. Kiva VCF System • Intra-operative Height Maintenance • Endplate-to-endplate Support • Preservation of Cancellous Bon • Reduced PMMA Cement Volume • Less Extravasation • Unipedicular Approach • Fully retrievable up to cement injection • All-in-One Disposable Device • Unique Over-the-Wire Peek Implant Delivery • Unilateral transpedicular approach • Pressure assisted bone cement injection The Kiva Implant is Designed to Provide
5. Materials and Methods 40 patients (22F – 18M mean age 68,8±12,4 years) 43 painful osteolytic vertebral lesions involving the vertebral wall 9 Myeloma- 31 Metastases • Pre-procedural CT and MR evaluation • Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) pre and post-procedural evaluation • Local Anesthesia • Monolateral approach • Hybrid fluoro-CT guidance (Philips Allura Xper CT) • Post-procedural CT evaluation
6. Male, 89 years, painful LungCa Mts in L4, L5 and Iliac Bone
7. Male, 65 years, painful LungCa MTS in T9, T10 and T11 ?
8. Male, 65 years, painful LungCa MTS in T9, T10 and T11
9. Male, 76 years, painful KidneyCa MTS in T11 and osteoporotic collapse of T12
10. Male, 56 years, painful ColonCa MTS in L2
11. Results
 Follow-up from 3 to 20 months (mean 7 months) Pain Evaluation VAS Before VAS After P-value 9.4±1.1 1.0±1.0 <0.0005 ODI Score Before ODI Score After P-value 84.1%±7.6 4.1%±3.3 <0.0005
12. Analgesic Drugs 24/40 pts (60%) suspended any pain medication 15/40 pts (37.5%) pain was completely controlled by Non-Steroidal Analgesic drugs 1 patient (2.5%) underwent surgical decompression for disease progression Results
 Follow-up from 3 to 20 months (mean 7 months)
13. Complications • No major complications • 1/40 pts (2.5%) reported new onset of backpain after 3 months for disease progression (treated with surgical decompression) • In 9/40 (22.5%) vertebrae an asymptomatic minimal PMMA leakage occurred • 3 discal (6.9%) • 6 paravertebral (13.9%)
14. Conclusions In painful metastases with involvement of the vertebral wall, peek implant assisted vertebroplasty is feasible, can achieve pain relief and reduction of PMMA leakage risk.