Abstract

OBJECTIVES: The risks associated with the procedure of kyphoplasty are low, but serious complications can occur as seen in the literature. These risks include spinal cord compression, nerve root compression, venous embolism, and pulmonary embolism including cardiovascular collapse. The purpose of this study was to observe all the parameters during the procedure under MAC (Monitoring Anaesthesia Control). DESIGN AND METHODS: Thirty-four (34) patients (58 vertebras) underwent 38 percutaneous kyphoplasty sessions between July 3, 2005, and February 4, 2008 time period. Causes thought to have been responsible for the vertebral body fractures in the patients treated, were: multiple myeloma (n = 12), osteoporosis (n = 11), metastatic disease from breast cancer (n = 4), lung cancer (n = 5), prostate cancer (n = 2). Twenty -three of these patients (23/34) had a history of malignancy and 12 had osteoporotic compression fractures. The maximum number of levels done in one setting was 3 (5 patients) With 16 patients having only 1 level intervened on, and 1 patient required 3 different settings. All patients underwent kyphoplasties in the operating room using biplanar fluoroscopy under local monitoring anaesthesia control (MAC). The mean age was 77.4 years. All patients were assessed with MAC during procedure and 30 minutes after. Also assessed , and then followed up after one, three and six months with Oswestry scale index. RESULTS: In all patients we observe decreased PO2 (5mmHg) (p<.005) after cement placement and more than 7mmHg after the second level placement in the same setting. Also after the third level of cement placement we have seen decreasing of more than 7mmHg (8.5mmHg). We also observe that in patients with multiple myeloma, the levels of PO2 are lower after cement placement compared with the other pathologies (p<.0003). Twenty-seven patients (27/34) exhibited significant and immediate pain improvement, 5 patients (5/34) responded within 5-7 days. Daily activities improved by 70.58 % (24/34) on the Oswestry scale. CONCLUSION: The risks associated with the procedure are low, but serious complications can occur if we have more than two levels in the same setting. We propose that the risk/benefit ratio in this procedure appears to be favourable in carefully selected patients and not than more than three levels in the same session.