Delayed Vertebral Augmentation With Spinejack Technique in A3 Type Vertebral Compression Fractures Poster No.: C-0358 Congress: ECR 2016 Type: Authors: Keywords: DOI: Scientific Exhibit J. Chiras; Paris Cedex Demineralisation-Bone, Vertebroplasty, Percutaneous, Musculoskeletal spine, Interventional non-vascular 10.1594/ecr2016/C-0358 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 12
Aims and objectives The efficacy of Spinejack device (Vexim SA) to reduce fresh vertebral fractures (#1 month) is well established [1, 2, 3]. Vertebral augmentation with Spinejack could be an alternative to treat such old fractures. Older painful (or symptomatic) fractures are usually treated by vertebroplasty but this technique is not able to reduce kyphosis or may be potentially dangerous in A3.2 and A3.3 fractures (Magerl classification), as it can be responsible of increased protrusion of bone fragment into the spinal canal. The objective of the study is to evaluate the feasibility and efficacy of a vertebral augmentation technique including an expandable implant system, SpineJack, in vertebral compression fractures A3 Magerl classification older than one month at the time of interventional procedure with important kyphosis, and for some cases displacement of posterior wall with bone fragments. Methods and materials Retrospective, monocentric, investigator initiated study on 19 patients (16 F, 3 M) presenting vertebral fractures with important kyphosis (11 cases) and/or intra spinal bone fragments (17 cases) were treated with Spinejack expansion device between one month and one year after occurrence of the fracture. The vertebral augmentation was realized under general anesthesia during a short hospitalization of 2 days. Patient age: 50-85 Kyphosis: #20#: 12/19 patients (0-37# max) Levels: T12:7; L1:11; L2:1 Number of fractures: 1 level: 18 patients; 4 levels: 1 patient Osteonecrosis: 12/19 patients Vertebra plana: 8/19 patients Fracture Types (Magerl Classification) in Fig. 1. Posterior Wall Displacement (Fig. 2) Page 2 of 12
12 patients with severe displacement 5 patients with moderate displacement 2 patients without displacement Treatment Modality Vertebral augmentation with SpineJack size 4.2: 18 patients; size 5.0: 1 patient. Fig. 3 SpineJack intravertebral implant. Concomitant vertebroplasty during procedure on adjacent levels: 10 cases: 1 on the upper vertebra, 3 on the lower vertebra and 6 cases on both. Images for this section: Fig. 1: Fracture Types (Magerl Classification) Page 3 of 12
Fig. 2: Posterior wall displacement Fig. 3: SpineJack intravertebral implant, unexpanded and after expansion Page 4 of 12
Results Immediate Results Immediate Kyphosis reduction after procedure Kyphosis reduction: # 25%: 76% Kyphosis reduction: #30%: 67% No clinical complication. Mid Term Results Bone fragment bulging : None No Clinical complication Pain reduction: VAS pre op: 6.85 (3-9) VAS post op: 2.1 (0-7) 2 patients had no significant pain reduction: 1 osteoporotic patient within 1 month post-op presented an adjacent fracture successfully treated by vertebroplasty and 1 patient presenting an old fracture with important kyphosis had partial kyphosis reduction of 10% New fractures: 2/19 patients 2 osteoporotic patients treated presented an adjacent fracture at 1 month post-op. CASE 1 68-year old female with a medical induced osteoporosis. Chronic fracture with posterior wall displacement, A3.1 fracture (Magerl classification) in L1 and fresh fractures in T10, T11 and L2. Kyphosis 32 and pre op VAS 9/10. Fig.4: Pre-op radiographs. Vertebral augmentation with SpineJack Ø 4.2mm and cement in L1 and concomitant vertebroplasty in T10, T11 and L2. Fig. 5: Post-op CT scans. Post-op results: reduction of the kyphosis 40%. Immediate results (1month): no reduction of pain and discovery of a new fracture in T12 requiring a vertebroplasty. Midterm results after complementary vertebroplasty (3 months): VAS 0/10. Normal walk. CASE 2 80-year old male with a L1 vertebral fracture 8 months ago, A3.2 in (Magerl classification). Fig. 6: Pre-op CT scans. Pre op Kyphosis 33 and VAS 6/10. Walking distance with two Page 5 of 12
canes: 50 meters. Vertebral augmentation with SpineJack Ø 4.2mm and cement in L1 and concomitant preventive vertebroplasty in T12. Fig. 7: Inter-op radiographs. Fig. 8: Post-op CT scan. Post-op results: reduction of the kyphosis 30%. Immediate results: reduction of pain, VAS: 2/10 Midterm results: VAS: 0/10. Patient able to walk for one hour without assistance. Images for this section: Fig. 4: CASE 1 Pre-op radiographs Page 6 of 12
Fig. 5: CASE 1 - Post-op result Page 7 of 12
Fig. 6: CASE 2 Pre-op CT scans Page 8 of 12
Fig. 7: CASE 2 Interoperative radiographs Page 9 of 12
Fig. 8: CASE 2 Post-op CTscan Page 10 of 12
Conclusion Vertebral augmentation with SpineJack device is feasible in vertebrae older than 3 months. This technique is helpful to treat safely A3.2 and A3.3 fractures (Magerl classification). Significant kyphosis reduction is obtained in about 67% of cases. In case of persistent significant kyphosis post-op, adjacent vertebroplasty should be performed during the same procedure in order to reduce the risk of new fracture. Personal information Professor Jacques Chiras Head of Department Dept. Neuroradiology Hôpital de la Pitié Salpétrière 75013 Paris France jacques.chiras@aphp.fr References [1]Krüger A, Baroud G, Noriega D, Figiel J, Dorschel C, Ruchholtz S, Oberkircher L. Height restoration and maintenance after treating unstable osteoporotic vertebral compression fractures by cement augmentation is dependent on the cement volume used. Clinical Biomechanics, vol. 28, no. 7, pp. 725-730, 2013. [2]D Noriega, A Krüger, F Ardura, N Hansen-Algenstaedt, F Hassel, X Barreau, J Beyerlein. Clinical Outcome after the Use of a New Craniocaudal Expandable Implant for Vertebral Compression Fracture Treatment: One Year Results from a Prospective Multicentric Study. BioMed Research International, vol. 2015, Article ID 927813, 7 pages, 2015. doi:10.1155/2015/927813. Page 11 of 12
[3]S Baeesa, A Krueger, F Aragón, D Noriega. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine. Saudi Med J 2015; Vol. 36 (1), 52-60. Page 12 of 12