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Double Sequential Ballooning (Eggshell) Method for Treatment of Severe Metastatic Compression Fractures with extra-compartment involvement: in comparison with Conventional Balloon Kyphoplasty
Sang Hoon Shin1, Jong Seok Lee2, Ho Shin Gwak1, Sang Hyun Lee3, Ji Woong Kwon1, Heon Yoo1, Jungnam Joo4
1Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea, Goyang, Korea
2Seoul National University College of Medicine, Seoul, Korea
3Department of Radiology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
4Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang, Korea
Correspondence  Sang Hoon Shin ,Tel: +82-31-920-1245, Fax: +82-31-920-2798, Email: nsshin@ncc.re.kr
Received: August 3, 2018;  Accepted: August 23, 2018.  Published online: August 23, 2018.
ABSTRACT
Objective Severely compressed vertebral fractures with extra-compartment involvement are considered relative contraindications for percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) in the fear of cement leakage or failure in vertebral height restoration. The purpose of the current study was to evaluate the effectiveness of a new technique known as double sequential ballooning (Eggshell) method for severe metastatic compression fractures with extra-compartment involvement.
Method
We retrospectively reviewed 118 patients with metastatic compression fracture who underwent BKP between March 2002 and September 2017. Among them, nine patients underwent BKP using the eggshell method. We analyzed the differences of radiological and clinical results between these two patients groups. Results Patients who underwent BKP using the eggshell method showed a higher frequency of severe compression (p=0.026), and more columns involvement as per six column classification (p=0.004) compared with those who underwent conventional BKP. They also showed higher frequency of paravertebral extension and paravertebral and epidural involvement (p<0.001). The median amount of injected cement was significantly higher in Eggshell group compared with conventional BKP (7.5 cc vs. 6 cc, p=0.049), and so, vertebral body (VB) height gain was (4 mm (range 2-9 mm) vs. 2.5 mm (range 0-10 mm), p=0.021). Patients in the eggshell group showed a lower rate of cement leakage, but the difference was statistically insignificant (p=0.273).
Conclusion
The eggshell method enabled injection of cement and restoration of vertebral height in patients with severe metastatic compression fractures with extra-compartment involvement in comparison with conventional BKP. It is expected to reduce cement leakage in these patients.
Key words: kyphoplasty; vertebral body compression fracture; vertebra plana; spine; surgical technique; cement leakage
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