Research on safety of single-stage multisegmental thoracolumbar percutaneous balloon vertebroplasty.

STUDY DESIGN: This is a prospective study evaluating the safety of single-stage multisegmental thoracolumbar percutaneous balloon vertebroplasty (PVP).

OBJECTIVE: To discuss the safety of single-stage multisegmental thoracolumbar PVP.

SUMMARY OF BACKGROUND DATA: The PVP is a minimally invasive surgery. It is mainly used in the treatment of individuals with serious back pain caused by osteoporotic compression fracture, vertebral metastatic tumors, symptomatic vertebral hemangioma, and multiple myeloma.

METHODS: A total of 50 patients underwent the PVP on 3 or more vertebras compared with 50 cases of PVP on 1 or 2 vertebras. Assessment indexes of safety were: operation time, intraoperative blood pressure change, intraoperative oxyhemoglobin saturation change, intraoperative mental state of patients, postoperative x-ray examination, and results of computed tomography and complications.

RESULTS: (1) Average operation time of group A was 125 minutes and that of group B was 56 minutes. (2) Change in arterial pressure of group A was more significant compared with group B, when assessed using the χ test. (3) Pain intensity of group A was compared with group B and a statistical difference was seen only in the patients who underwent PVP on 3 or more vertebras on the first day after surgery. (4) Change in oxyhemoglobin saturation (decreased under 90%) of group A was found to be more significant compared with group B, when assessed using the χ test. (5) No statistical difference in emotional state was found between the 2 groups. (6) There were 4 cases of perivertebral leakage, 1 case of intrapulmonary leakage, and 2 cases of symptoms of intercostal nerve stimulation in group A and 3 cases of perivertebral leakage, 1 case of intrapulmonary leakage, and 1 case of symptoms of intercostal nerve stimulation in group B.

CONCLUSIONS: High risk exists in single-stage multisegmental thoracolumbar percutaneous vertebroplasty, especially during puncture and bone cement injection, which may cause wide fluctuation of blood pressure and reduce oxygen saturation sharply; however, the surgery is safe to a certain extent, although it requires close intraoperative supervision and shortened operation time.