Nowadays, there are more and more elderly people around, and China has gradually entered into an aging society, and the treatment of geriatric diseases has received increasing attention from the society. Among them, osteoporosis is often overlooked because of its insidiousness and prevalence, and it is only after a fracture occurs that people pay attention to it, so it is called the “silent epidemic”.
Osteoporosis is a systemic disease in which the amount of bone in the skeleton decreases and bone strength decreases, making the brittleness of bone more brittle and prone to fracture. Among osteoporotic fractures, a large proportion of fractures occur in the spinal vertebrae. It is estimated that about 1/3 of women and 1/5 of men over the age of 50 are at risk for osteoporotic fractures. There are approximately 45 million osteoporotic vertebral compression fractures in China, and the number is increasing by the millions each year.
More than 75% of people with osteoporotic vertebral compression fractures suffer a fracture simply from an unintentional cough or sneeze, or even from no trigger at all. Some patients often believe that the early onset of low back pain in osteoporotic vertebral compression fractures is just an accidental sprain, thus missing the best time for treatment until the condition worsens and the low back pain does not decrease significantly with bed rest, making it impossible to walk upright or sit up.
Some patients will choose conservative treatment and are unwilling to undergo surgery. Treatment is carried out through bed rest and local pain relief. However, there are great hazards for elderly people who are bedridden for a long time.
The main ones are.
①Bone loss and bone strength loss continue to progress and increase the occurrence of fractures in other areas;
②Decreased muscle strength, resulting in muscle atrophy of the limbs;
(③) susceptibility to decubitus ulcers and complications of infection;
④Easy to induce deep vein thrombosis and pulmonary embolism;
⑤ Decreased cardiopulmonary function, which may lead to pneumonic pneumonia.
Therefore, getting patients out of bed as soon as possible, rapidly relieving pain and improving their quality of life are important goals in the treatment of osteoporotic vertebral fractures. For conventional surgical treatment, the large trauma, the insufficient holding power of surgical instruments such as pedicle internal fixation screws on the osteoporotic vertebral body, and the decreased tolerance of elderly patients to surgery make it difficult to perform conventional open surgical treatment. This has made the treatment of osteoporotic vertebral fractures through minimally invasive surgery a necessary development, providing the prerequisite for percutaneous injection of fillers into the diseased vertebrae with the help of imaging equipment.
Thus, in recent years, percutaneous vertebroplasty (PVP) and posteromedial kyphoplasty (PKP) using minimally invasive techniques have become the mainstay of treatment for osteoporotic spine fractures in the elderly, thanks to the advantages of precise pain relief, minimal invasiveness, safety, economy, and few complications.
What are percutaneous vertebroplasty (PVP) and posteromedial kyphoplasty (PKP)?
PVP is a minimally invasive spine surgery technique that is performed under imaging guidance by injecting bone cement into the vertebral body after percutaneous puncture of a puncture needle into the diseased vertebral body in order to relieve low back pain, enhance the strength and stability of the vertebral body, prevent collapse, and even partially restore the height of the vertebral body.PKP is a technique that uses a balloon to expand the vertebral body based on PVP.
PVP.
PKP: fractured vertebral body, puncture to establish access, expandable balloon, and filling with bone cement.
The patient is positioned on a prone basis, guided by intraoperative imaging, and punctured into the diseased vertebral body by means of special puncture instruments. Bone cement injection is then performed under the assessment of the imaging equipment. After the cement injection is completed, the procedure is completed when the bone cement sets.
Puncture needle penetration into the diseased vertebral body.
Bone cement injection is performed.
The black portion is the bone cement, which reinforces the vertebral body:.
Postoperative recovery of the wound.
What are the indications for PVP and PKP?
Currently, vertebroplasty is used for painful vertebral disorders, mainly for osteoporotic vertebral compression fractures. In addition, it can also be used for the palliative treatment of vertebral hemangiomas and certain malignant tumors of the vertebral body.
(i) vertebral compression fractures with significant pain symptoms, <3 months, and where non-surgical treatment is ineffective;
(ii) vertebral compression fractures of >3 months in which there is non-union of the fracture;
(iii) vertebral compression fractures with significant progressive development of kyphosis;
(iv) The degree of compression of the vertebral body should maintain at least 1/3 of the original vertebral body height.
Some scholars have included vertebral compression fractures of age >55 years as one of their required indications.
What are the advantages of PVP and PKP?
①Minimally invasive, low bleeding, local anesthesia;
②Good pain relief, generally within a few hours or days after surgery, and some patients have obvious pain and improvement of limb movement immediately after surgery;
③Reinforcing the vertebral body and restoring the strength of the vertebral body;
④Early functional exercise to resume daily activities and significantly reduce complications;
⑤ Prevention of further collapse of the vertebral body and posterior convexity deformity;
⑥Improve the survival quality of patients;
(7) solving the problems of the elderly who cannot tolerate major surgery, the lack of firm internal fixation in osteoporosis and the difficulty in treating multivertebral fractures.
Precautions for patients after PVP and PKP surgery?
①The bone cement can be completely solidified in a few minutes after injecting into the diseased vertebral body, and the back pain can be relieved, so the patient can get up and walk out of bed independently about 2-4 hours after PVP and PKP;
②Patients should avoid excessive bending and weight-bearing after surgery to avoid trauma. After discharge, patients should be encouraged to do more outdoor activities and receive anti-osteoporosis treatment such as calcium supplementation and bisphosphonates to slow down the development of osteoporosis. Once the recurrence of severe pain in the thoracolumbar back, which cannot be relieved for several days, the patient should be highly alert to new vertebral fractures and be examined as soon as possible.