Vertebroplastie en Allemagne S. Hennigs

Transcript

1. 5.2.2011 Knappschaftskrankenhaus Bottrop Vertebroplastie en Allemagne – Long term follow up of a large number of patients Dr. Svenja Hennigs
2. 5.2.2011 Knappschaftskrankenhaus Bottrop Background Vertebral compression fractures and associated complications incur high health care costs. Due to the evident demographical changes their incidence is expected to grow, increasing the importance of reliable and efficient interdiscipllinary treatment modalities
3. 5.2.2011 Knappschaftskrankenhaus Bottrop Purpose of the study Prospectively assess the quality of life in patients treated with percutaneous vertebroplasty in a midterm follow-up of 12 months, taking the underlying etiology into account
4. 5.2.2011 Knappschaftskrankenhaus Bottrop Methods Prospective multicentre study* comprising pain, mobility and use of analgesic agents in categorial scales 24h pre- and postinterventionally and in constant intervals up to 12 months, constantly acquired by the same interviewer * Vertebroplasties of 3 hospitals between 2002 and 2008
5. 5.2.2011 Knappschaftskrankenhaus Bottrop Criteria of inclusion ! acute or subacute VBF, resistant to conservative therapy ! fracture age maximum 3 months ! fracture diagnosis (x-ray/CT/MRI/scintigraphy)
6. 5.2.2011 Knappschaftskrankenhaus Bottrop Criteria of exclusion " Systemic infection " coagulation disorder " Unstable VBF " focal-neurological deficits " allergy to PMMA
7. 5.2.2011 Knappschaftskrankenhaus Bottrop technique of vertebroplasty
8. 5.2.2011 Knappschaftskrankenhaus Bottrop - bipedicular - 13 to 11 gauge bevelled shaped needles - 2 to 4 ml PMMA cement - fluoroscopy
9. 5.2.2011 Knappschaftskrankenhaus Bottrop Results " n= 1188 patients, 1980 VBF`s " female/male : 772/416 " 75% with osteoporosis, 16% with tumorous VBF and 9% with traumatic VBF. " Most common vertebral body to fracture: lumbar vertebra level 1 thoracic vertebra level 8
10. 5.2.2011 Knappschaftskrankenhaus Bottrop Results " 964 patients (81%) were investigated throughout the whole follow- up period of 12 months.
11. 5.2.2011 Knappschaftskrankenhaus Bottrop Results –pain score all groups 1 day before tx 12 months after tx – highly significant improvement
12. 5.2.2011 Knappschaftskrankenhaus Bottrop Results – pain score with different causes for # 6 months 6 months 6 months
13. 5.2.2011 Knappschaftskrankenhaus Bottrop Group 1 - Osteoporosis Group 2 - Tumour 0 0,5000 1,0000 1,5000 2,0000 Mittelwert - QOL, 1T v A Mittelwert - QOL, 1T n A Mittelwert - QOL, 7T n A Mittelwert - QOL, 3M n A Mittelwert - QOL, 6M n A Mittelwert - QOL, 1J n A 0 0,7500 1,5000 2,2500 3,0000 Mittelwert - QOL, 1T v A Mittelwert - QOL, 1T n A Mittelwert - QOL, 7T n A Mittelwert - QOL, 3M n A Mittelwert - QOL, 6M n A Mittelwert - QOL, 1J n A Amount of analagetics up to 12 months
14. 5.2.2011 Knappschaftskrankenhaus Bottrop Group 1 - Osteoporosis Group 2 - Tumour 0 0,5000 1,0000 1,5000 2,0000 Mittelwert - QOL, 1T v M Mittelwert - QOL, 1T n M Mittelwert - QOL, 7T n M Mittelwert - QOL, 3M n M Mittelwert - QOL, 6M n M Mittelwert - QOL, 1J n M 0 0,5000 1,0000 1,5000 2,0000 Mittelwert - QOL, 1T v M Mittelwert - QOL, 1T n M Mittelwert - QOL, 7T n M Mittelwert - QOL, 3M n M Mittelwert - QOL, 6M n M Mittelwert - QOL, 1J n M Mobility up to 12 months
15. 5.2.2011 Knappschaftskrankenhaus Bottrop Complications " No relevant (organ-emboly, infections or neurological symptoms) " 15% cement dislocation in paravertebral venous plexus (180 asymptomatic cases) " Medial pedicl e wall: never cross it!! with needle " dorsal vertebral quarter: never cross!! with cement " fluoroscopy : Stop as soon as you see cement in veins or extravertebral!! " consistency of cement: inject late!!! Tooth paste like
16. 5.2.2011 Knappschaftskrankenhaus Bottrop Points of critics " Negativa: no randomization " Positiva: " Biggest cohort in Germany " Strict follow-up " Few studies with evaluation of all three parameters throughout 12 months " low rate of complications
17. 5.2.2011 Knappschaftskrankenhaus Bottrop Take home points " pain, analgetics mobility significantly in all 3 groups for the whole follow-up " viscosity amount of cement leakage-rate " highly significant clinical improvement 1 day postinterventionally and increasing up to 6 months " Publication Dt.Ärzteblatt 2011
18. 5.2.2011 Knappschaftskrankenhaus Bottrop MERCI !