Zouboulis Augmentation

8/7/2019 Zouboulis Augmentation

1/20

Vertebral augmentation

Assistant Professor, Department of Orthopaedics,

Patras University, GREECE

Olympion Hospital and Rehabilitation Center, Patras

Elected President, Spine Division, Greek Orthopaedic

Society for year 2011 Interest:

MIS, Aging spine

Rehabilitation

Medical education, training and evaluating MIS

techniques

Enjoys Basketball, Gym, Travel, Social Networking

Contact: [email protected] E. Zouboulis,

MD, PhD


2/20

Vertebral augmentation

Panayotis E. ZouboulisAssistant Professor Orthopaedics

University of Patras

GREECE

Disclosure:

consultant, stockholderAlphatec Spine


3/20

A review of complications associated with vertebroplasty

and kyphoplasty as reported to the Food and Drug Administration

medical device related web site.

Nussbaum DA et al, J Vasc Interv Radiol 2004

Literature review

PMMA hypotension

embolic disease death (> 3 levels)

cement leakage (neurologic complications greater vessels?)


4/20

Literature review (c ed)

Garfin SA et al, Spine 2001

overall risk

0.7% per level

1.2% per patient

0

10

20

30

40

50

60

primary osteoporosis secondary osteoporosis trauma tumor

2002 2008 balloon kyphoplasty

101 pts 200 levels


5/20

Fribourg D et al, Spine 2004

...subsequent adjacent fractures, especially during

the first 2 months after the index procedure.

Villarraga ML et al, J Spinal Disord Tech 2005

may be related to the underlying etiology (weakening of the bone)

rather than the surgical intervention.

3m p.op.

Adjacent level fracture



6/20

Monticelli F et al, Forensic Sci Int 2005

Zaccheo MV et al, Am J Emerg Med 2008

Kao FC et al, Spine 2008

Lim KJ et al, Anesth Analg 2007

Pulmonary embolism

Mortality rate 0.4%CT-guided vertebroplasty: analysis of technical results,

extraosseous cement leakages and complications in 500 cases.

Pitton MB et al, Eur Radiol 2008

Balloon kyphoplasty and vertebroplasty for VCF:

a comparative systematic review of efficacy and safety.

Taylor RS et al, Spine 2006



7/20

internal brace

Implant expandable device


8/20

Star shaped

interdigitationBone captured within

implant

Cement

extruding from

implant andgrabbing

bone

Tip of implant

Observations


9/20

-0,45

-0,40

-0,35

-0,30

-0,25

-0,20

-0,15

-0,10

-0,05

0,00

HeightLoss(

cm)

Collapse of Repaired Vertebral Bodies Following Testing

Kyphoplasty

Implant

p


10/20

Biomechanical data

0

0,5

1

1,5

2

2,5

3

3,5

Volume(mL)

Cement Injection Volume

Implant

Kyphoplastyp


11/20


12/20

Osteoporosis

P.G. female, 72y

4m p.op.


13/20

Secondary osteoporosis

Stenosis - kyphotic deformity

1y p.op.

G.L. female, 75y


14/20

Acute trauma

S.N. male, 38y

p.op.


15/20

Acute trauma

Z.D. male, 52y

6m p.op.


16/20

p.op.

Ca uterus

L.M. female, 58y


17/20

Ca prostate

CML

1,5y p.op.

P.A. male, 71y


18/20

Ca colon

H.G. female, 84y


19/20

Results

46 patients, 111 levelsmean age 66,4 y

1y p.op.

VAS 51mm ODI 25.1

height restoration 9% (7% last follow up)

kyphotic angle 3.7 (2.9 last follow up)

6 adjacent level fractures

No pulmonary embolism

No severe cement leakage


20/20

Conclusions

Improved clinical results

Well tolerated by respiratory restricted patients

Expanded indications

acute trauma (stand-alone device?)osteolytic lesions

combined open/MIS procedures

Adjacent level fractures?

Zouboulis Augmentation

Documents

Transcript of Zouboulis Augmentation