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Vol. 22. Núm. 6.Enero 2011Páginas 488-607
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Vol. 22. Núm. 6.Enero 2011Páginas 488-607
DOI: 10.1016/S1130-1473(11)70117-8
Fuga intrarraquídea de cemento biológico tras cifoplastia. Evolución a largo plazo. Presentación de un caso y revisión de la literatura
Biological cement extravasation into the spinal canal following kyphoplasty. Long-term follow-up. Report of one case and review of the literature
Visitas
1908
J.V. Martínez-Quiñones??
Autor para correspondencia
, J. Aso-Escario, F.E. Consolini, R. Arregui-Calvo
Servicio de Neurocirugía. Hospital MAZ. Zaragoza
J.M. Medina-Imbroda*, J. Pons Bosque**
* Servicio de Neurocirugía. Hospital Regional Universitario Carlos Haya. Málaga
** Servicio de Radiología. Hospital MAZ. Zaragoza
Visitas
1908
Información del artículo
Resumen
Introducción

. La vertebroplastia y la cifoplastia son técnicas percutáneas mínimamente invasivas indicadas en el tratamiento de ciertas fracturas somáticas vertebrales. Ambas se basan en la introducción dentro del cuerpo vertebral de una sustancia llamada genéricamente cemento, el cual puede ser acrílico o biológico. Son técnicas no exentas de riesgos, destacando como principal complicación la extravasación del cemento. Dada la corta experiencia en el uso de cementos biológicos, existen hoy en día muchas dudas sin resolver acerca de su comportamiento a largo plazo, especialmente en caso de que se produzca una fuga del material de refuerzo vertebral.

Objetivo

. Presentamos un caso de extravasación intrarraquídea de cemento biológico durante una cifoplastia en un varón de 23 años y su evolución a largo plazo (3 años), realizando una revisión de la literatura publicada al respecto.

Conclusiones

. La mayoría de los estudios publicados tratan sobre la evolución del material de refuerzo dentro de un ambiente óseo, pero no hacen referencia a cómo evolucionaría el mismo fuera del espacio vertebral. Hemos apreciado, en nuestro caso, que el cemento extravasado no está siendo sustituido por hueso, sino que está sufriendo un proceso de reabsorción. La extravasación del material de refuerzo vertebral es una complicación importante y potencialmente grave de las técnicas de refuerzo vertebral percutáneo. Para evitarla se requiere una rigurosa técnica quirúrgica bajo control radioscópico. Los cementos biológicos tienen la ventaja de ser biocompatibles, biodegradables y osteoconductivos. La elección del cemento dependerá de las características de la interacción balón-trabécula.

Palabras clave:
Vertebroplastia
Cifoplastia
Cemento biológico
Fuga de cemento
Interacción balón-trabécula
Abreviaturas:
α-1-FP
ACP
bFGF
BMP-2
CEA
CP
DCPA
DCPD
HA
MCPM
OCP
PC
PDGF
PMMA
RNM
TC
TCP
TGF-β
TTCP
UH
VP
Summary
Background

Vertebroplasty and kyphoplasty are minimally invasive percutaneous techniques indicated in the treatment of some somatic vertebral fractures. Both are based on the introduction of a substance, called cement, inside the vertebral body. We can choose acrylic or biological cement. These techniques are not risk-free, cement extravasation being the main complication. Due to the short experience in the use of the biological cements, nowadays there are a lot of unresolved doubts about the long-term behaviour of these materials, especially in the case of leakage.

Purpose

. We report a case of biologic cement extravasation into the spinal canal during a kyphoplasty in a 23 year old man and its long-term follow-up (3 years), performing a review of the scientific literature related to the topic.

Conclusions

. Most of the papers in the literature discuss the behaviour of the reinforcement material inside a bony environment, but they do not refer to the evolution of the cement outside the vertebral space. We have appreciated in our case that the leaked cement is not being substituted for bone but it suffers a process of progressive resorption. The extravasation of the vertebral reinforcement material is an important and potentially serious complication of the vertebral augmentation techniques. To avoid this, a very precise chirurgical technique is necessary, under radiological guidance. Biocompatibility, biodegradability and osteoconductivity are the main advantages of biological cemnets. We base the choice of the cement on the balloom/trabeculae interaction.

Key words:
Vertebroplasty
Kyphoplasty
Biologic cement
Cement leakage
Balloon/trabeculae interaction
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Martínez-Quiñones, J.V.; Medina-Imbroda, J.M.; Aso-Escario, J.; Pons Bosque, J.; Consolini, F.E.; Arregui-Calvo, R.: Fuga intrarraquídea de cemento biológico tras cifoplastia. Evolución a largo plazo. Presentación de un caso y revisión de la literatura. Neurocirugía 2011; 22: 588–599.

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