Kyphoplasty with purified silicone VK100 (Elastoplasty) to treat spinal lytic lesions in cancer patients: A retrospective evaluation of 41 cases.

Autori:Telera S, Pompili A, Crispo F, Giovannetti M, Pace A, Villani V, Fabi A, Sperduti I, Raus L.
Pubblicato su:Clin Neurol Neurosurg. 2018 Jun 15;171:184-189. DOI: 10.1016/j.clineuro.2018.06.018 .

Presentazione

Neurochirurghi e neuro-oncologi dell’Istituto Regina Elena di Roma presentano la loro esperienza sulle cifoplastiche nelle fratture vertebrali secondarie a localizzazioni metastatiche. Si discutono la tecnica chirurgica, le complicanze ed i risultati di 70 fratture trattate con utilizzo di un polimero denominato VK100, per le caratteristiche del quale la tecnica viene denominata elastoplastica.

Abstract

OBJECTIVES: Balloon Kyphoplasty (BKP) for vertebral compression fractures (VCFs) in cancer patients is more challenging than for osteoporotic ones. Cord compressions are frequent and the incidence of complications ten-fold greater. Polymethylmetacrylate (PMMA) is the gold standard material for BKP but has disadvantages: exothermic reaction, short working time, rapid solidification, absence of osteoconduction. VK100 is a mixture of Dimethyl Methylvinyl siloxane and Barium Sulphate. It is elastic, adhesive to bone, leaves 30 min before solidification without exothermic reaction, and shows a stiffness close to the intact vertebrae. The surgical procedure, called elastoplasty, is similar to a BKP. Clinical results obtained with this new silicone in pathological VCFs have been investigated.

PATIENTS AND METHODS: 41 cancer patients with symptomatic VCFs (70 vertebral bodies), underwent percutaneous and open elastoplasties. Post-operative leakages, pulmonary embolism (PE) and adjacent fractures were carefully evaluated with neuroimaging. KPS, VAS and Dennis Pain Score were calculated pre- post-operatively and at the last follow-up.

RESULTS: The mean volume of silicone inserted in each vertebra was 3.8 cc. Complications included seven leakages (17%), two asymptomatic PE (4.3%) and 3 post-operative adjacent fractures (7.3%). Median follow-up was 29 months. A significant improvement was observed in KPS, VAS and Dennis Pain Score (p < .0001). The 1-yr survival rate was 76.9%.

CONCLUSIONS: Elastoplasty appears a safe and effective palliative treatment of VCFs in oncologic patients. Useful qualities of VK100 are the lack of exothermic reaction and the wider working window. The influence of biomechanical properties of silicone on reduction of adjacent level fractures requires further investigations.

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