Efectos sobre el uso de analgésicos después de cementoplastía percutánea
Effects on Analgesia Use Following Percutaneous Spinal Augmentation and Cementoplasty: Sustained Significant Decrease
Duncan Street, MRCP (UK)1; John F. Morlese, FRCR1; Amit Shah, BSc, FRCR1; Steven Morgan, FRCR2; Mamta Garg, MD, FRCP, FRCPath (Hematology)1; Winston J. Rennie, MSc, FRCR1,3
Introduction: Percutaneous spinal augmentation and cementoplasty (PSAC) is a minimally invasive procedure used to treat or prevent pathologic fractures and pain when other pain management is ineffective. Previous reports have demonstrated significant subjective pain and symptom relief through questionnaires and quality of life scoring frameworks, but no work has yet been performed focusing on the more objective measure of long-term analgesia use as a primary outcome. Materials and Methods: All patients who attended the preassessment vertebroplasty clinic at a tertiary referral center in the United Kingdom over a 1-year period (2011) were identified retrospectively using electronic hospital clinic records. Repeat prescription documentation was obtained from the patient’s general practitioner or inpatient hospital records and compared to preassessment analgesia documentation with statistical significance calculated using a Fisher exact test (P=.05). End points were set at early 2015 or natural death. Results: Forty-six patients (65% female, age range 26-88 years, median age 72 years) were assessed. Of these, 21 (46%) had a diagnosis of osteoporosis, and 25 (54%) had a cancer-related diagnosis. Twenty-seven (59%) had a PSAC procedure performed within a year of their preassessment and 19 (41%) were deemed unsuitable. Of the 27 patients who underwent a PSAC procedure, a statistically significant (P=.0188) decrease in analgesia use, as defined by the WHO pain ladder, was noted in 17 (63%) when compared with those who did not undergo the procedure. This was principally accounted for by a strongly significant decrease in the osteoporosis subset (P=.00752). There was no significant relationship to age or sex of patient. Conclusions: This study demonstrates that PSAC leads to a highly significant, long-term, sustained reduction in analgesia use in patients with osteoporotic lesions.
Key words: analgesia, vertebroplasty, cementoplasty, pain, osteoporosis, palliation
La efectividad de la vertebroplastía percutánea es determinada por la condición específica del hueso y la estrategia de tratamiento
The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy.
Widmer Soyka RP1, Helgason B1, Hazrati Marangalou J2, van den Bergh JP3,4, van Rietbergen B2, Ferguson SJ1.
PLoS One. 2016 Apr 21;11(4):e0151680. doi: 10.1371/journal.pone.0151680. eCollection 2016.
PURPOSE: Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. METHODS:
A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. RESULTS: The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. CONCLUSIONS: We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.
Los factores de riesgo de colapso vertebral adyacente tras vertebroplastia percutánea de fractura vertebral osteoporótica en mujeres posmenopáusicas.
Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women.
Takahara K1, Kamimura M2, Moriya H3, Ashizawa R4, Koike T5, Hidai Y6, Ikegami S7, Nakamura Y8, Kato H9.
BMC Musculoskelet Disord. 2016 Jan 12;17:12. doi: 10.1186/s12891-016-0887-0.
BACKGROUND: Recently percutaneous vertebroplasty (PVP) was frequently performed for treatment of osteoporotic vertebral fractures (VFs). It is widely accepted that new compression fractures tend to occur adjacent to the vertebral bodies, typically within a month after PVP. To determine the risk factors among several potential predictors for de novo VFs following PVP in patients with osteoporosis. METHODS: We retrospectively screened the clinical results of 88 patients who had been treated by PVP. Fifteen cases were excluded due to non-union. Of the remaining 73 patients, 19 (26.0%) later returned with pain due to a new vertebral compression fracture. One patient with a non-adjacent fracture and 2 patients with adjacent factures occurring 3 months later were excluded from the study. The 9 male patients were excluded to avoid gender bias. Ultimately, we divided the 61 remaining postmenopausal female patients (mean age: 78.9 years) into the collapse group (14 patients) who had experienced adjacent vertebral collapse after PVP and the non-collapse group (47 patients) who had not. Logistic regression analysis was performed to identify the risk factors for new VFs after PVP. RESULTS: All 14 cases of adjacent VF occurred within the first month after surgery. The collapse group had significantly advanced age, higher urinary N-terminal cross-linking telopeptide of type I collagen, and lower lumbar and hip bone mineral density (BMD) scores as compared with the non-collapse group. The odds ratios for age, lumbar, total hip, femoral neck, and trochanteric BMD were 4.5, 8.2, 4.5, 7.2, and 9.6, respectively. Positive likelihood ratios suggested that age more than 85 years, lumbar BMD less than 0.700 [-2.6SD], total hip BMD less than 0.700 [-1.8SD], neck BMD less than 0.600 [-2.1], and trochanter BMD less than 0.600 conferred an elevated risk of adjacent VF. CONCLUSIONS: Our study revealed that advanced age and decreased lumbar and hip BMD scores most strongly indicated a risk of adjacent VF following PVP.
XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016
Información / Information
L Congreso Mexicano de Anestesiología
Noviembre 2-6, 2016
17h World Congress of Anaesthesiologists, WFSA
Sep 6-11, 2020
Prague, Czech Republic