Open kyphoplasty for management of metastatic spine fracture

Introduction. - Metastatic spine fractures are very frequent, often occurring in patients with severe medical conditions. Open kyphoplasty and vertebroplasty are part of the classic management of this of fracture. In certain conditions such as spinal cord compression caused by epidural metastatic cancer or collapse of the vertebral body implying a local kyphosis, surgery should allow decompression of the spinal cord and stabilisation of the spine in a simple act. The purpose of this study is to assess a surgical technique combining surgical decompression by laminectomy frequently associated with posterior transpedicular instrumentation and at the same time, an open kyphoplasty to stabilize the anterior part of the spine. Material and methods. - The same procedure was performed in 14 patients during an 18-month period. The average age of the patients was 54 years. All patients suffered severe pain before the surgical procedure (VSA mean: 7). Neurological deficiency was noted in 10 of the 14 patients with this spinal cord compression. Nineteen vertebrae were treated; a short posterior instrumentation was necessary in I I patients. The average operative time was 90 minutes. Of the patients with neurological deficiency, the clinical status improved after surgery in all. The average VSA of this series 3 days after surgery was 2. The mean quantity of PMMA injected was 7 cc. Two PMMA leaks, one in the intervertebral disc and one forward, were identified on the postoperative CT scan. The average hospital stay was 7 days. Conclusion. - This procedure enables surgical decompression, vertebral body consolidation and consequently spinal stabilization of the spine. We did not have any complications related to this procedure which, particularly for the elderly population, is an attractive alternative to major surgery such as vertebrectomy. (c) 2007 Elsevier Masson SAS. Tous droits reserves.