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Chinangwa cheCureus ndechekushandura iyo yakagara iripo modhi yekudhindisa yezvokurapa, umo kuendesa tsvakiridzo kunogona kudhura, kwakaoma, uye kutora nguva.
Neuroradiology, vertebral transfer, cervical vertebroplasty, posterolateral approach, curved tsono, interventional neuroradiology, percutaneous vertebroplasty.
Taura chinyorwa ichi se: Swarnkar A, Zain S, Christie O, et al.(Chivabvu 29, 2022) Vertebroplasty yepathological C2 fractures: yakasarudzika kiriniki kesi uchishandisa yakakombama tsono nzira.Kurapa 14(5): e25463.doi:10.7759/cureus.25463
Minimally invasive vertebroplasty yakabuda seimwe nzira inoshanda yekurapa pathological vertebral fractures.Vertebroplasty yakanyatsorongedzerwa mu thoracic uye lumbar posterolateral nzira, asi haiwanzoshandiswa mumutsipa wekervical pamusana pezvizhinji zvakakosha neural uye vascular structures inofanira kudziviswa.Kushandiswa kwehunyanzvi hwekuita uye kufungidzira kwakakosha kushandura zvimiro zvakakosha uye kuderedza njodzi yematambudziko.Mune posterolateral nzira, chironda chinofanira kunge chiri panzvimbo yakananga tsono trajectory lateral kune C2 vertebra.Iyi nzira inogona kudzikamisa kurapwa kwakakwana kwemamwe maronda ari pakati nepakati.Isu tinotsanangura yakasarudzika kiriniki kesi yeyakabudirira uye yakachengeteka posterolateral nzira yekurapa inoparadza medial C2 metastases uchishandisa tsono yakakombama.
Vertebroplasty inosanganisira kuchinjwa kwezvinhu zvemukati zvemuviri we vertebral kugadzirisa kuputsika kana kusagadzikana kwemaitiro.Simenti inowanzoshandiswa sechinhu chekuputira, zvichiita kuti kuwedzerwa simba re vertebrae, kuderedza ngozi yekudonha, uye kuderera kwemarwadzo, kunyanya kune varwere vane osteoporosis kana osteolytic bone lesions [1].Percutaneous vertebroplasty (PVP) inowanzoshandiswa sechinhu chinopindirana neanalgesics uye neradiation therapy kuti ibvise marwadzo kune varwere vane vertebral fractures yechipiri kune yakaipa.Iyi nzira inowanzoitwa mu thoracic uye lumbar spine kuburikidza ne posterolateral pedicle kana extrapedicular approach.PVP kazhinji haisati yaitwa mumutsara wekervical nekuda kwehukuru hudiki hwemuviri we vertebral uye matambudziko ehunyanzvi anoenderana nekuvapo kweakakosha neurovascular structures mumutsipa wekervical senge musana, carotid arteries, jugular veins, uye cranial nerves.2].PVP, kunyanya paC2 level, inenge isingawanzoitiki kana kuti yakawanda nekuda kwekuoma kweanatomical uye kubatanidzwa kwebundu paC2 level.Mumamiriro ezvinhu asina kugadzikana osteolytic maronda, vertebroplasty inogona kuitwa kana nzira yacho ichionekwa yakaoma zvikuru.MuPVP maronda eC2 vertebral miviri, tsono yakatwasuka inowanzoshandiswa kubva kune anterolateral, posterolateral, shanduro, kana transoral (pharyngeal) nzira yekudzivisa zvivako zvakakosha [3].Kushandiswa kwetsono yakatwasuka kunoratidza kuti chironda chinofanirwa kutevedza nzira iyi yekurapa kwakakwana.Zvironda zviri kunze kwenzira yakananga zvinogona kuguma nekugadzirisa, kusakwana, kurapwa kana kubviswa zvachose kubva pakurapa kwakakodzera.Iyo yakakomberedzwa tsono PVP nzira ichangobva kushandiswa mulumbar uye thoracic musana nemishumo yekuwedzera maneuverability [4,5].Zvisinei, kushandiswa kwetsono dzakakombama mumutsipa wekervical hakuna kutaurwa.Isu tinotsanangura chiitiko chekiriniki cheiyo isingawanzo C2 pathologic fracture yechipiri kune metastatic pancreatic cancer inobatwa neiyo posterior cervical PVP.
Mumwe murume ane makore 65 okukura akaunzwa kuchipatara nekurwadziwa kutsva pabendekete rake rekurudyi nemutsipa izvo zvakaramba zviripo kwemazuva gumi pasina zororo nemishonga inopfuura-the-counter.Zviratidzo izvi hazvibatanidzi nechiveve chero chipi zvacho kana kupera simba.Aive nenhoroondo yakakosha yemetastatic isina kunyatsosiyaniswa pancreatic cancer stage IV, arterial hypertension uye kudhakwa kwakanyanya.Akapedza 6 cycles yeFOLFIRINOX (leucovorin/leucovorin, fluorouracil, irinotecan hydrochloride uye oxaliplatin) asi akatanga chirongwa chitsva che gemzar uye abraxane masvondo maviri apfuura nekuda kwekufambira mberi kwechirwere.Pakuongororwa kwemuviri, akange asina hunyoro hwekupuruzira cervical, thoracic, kana lumbar spine.Mukuwedzera, pakanga pasina kukanganiswa kwekunzwa uye motokari mumakumbo epamusoro nepamusoro.Mafungiro ake maviri aive akajairika.An out-of-hospital computed tomography (CT) scan of the cervical spine yakaratidza maronda e osteolytic anoenderana nechirwere chemetastatic chinosanganisira rutivi rworudyi rweC2 vertebral body, yakarurama C2 mass, pedyo nekurudyi vertebral plate, uye rutivi rwakaora mwoyo rweC2. .Upper right articular surface block (Fig. 1).A neurosurgeon akabvunzwa, magnetic resonance imaging (MRI) yekervical, thoracic uye lumbar spine yakaitwa, ichifunga nezve metastatic osteolytic maronda.MRI yakawana yakaratidza T2 hyperintensity, T1 isointense soft tissue mass inotsiva rutivi rworudyi rweC2 vertebral body, ine zvishoma kupararira uye post-contrast enhancement.Akagamuchira kurapa kwemwaranzi pasina kuvandudzwa kunoonekwa mukurwadziwa.The neurosurgical service inokurudzira kusaita kuvhiya kwechimbichimbi.Nokudaro, interventional radiology (IR) yaidiwa kuti iwedzere kurapwa nekuda kwekurwadziwa kwakanyanya uye njodzi yekusagadzikana uye zvinogona kuitika musana wepinini.Mushure mekuongorora, zvakasarudzwa kuita CT-inotungamirirwa neC2 spine plasty uchishandisa nzira yeposterolateral.
Panel A inoratidza zvakasiyana uye cortical irregularities (miseve) kurudyi anterior side yeC2 vertebral body.Asymmetric kuwedzera kwekurudyi atlantiaxial joint uye cortical irregularity paC2 (museve wakakora, B).Izvi, pamwe chete nekujeka kwehuwandu kune rumwe rutivi rworudyi rweC2, zvinoratidza kuparara kwepathological.
Murwere akaiswa kurutivi rworudyi akarara uye 2.5 mg yeVersed uye 125 μg ye fentanyl yakashandiswa muzvikamu zvakakamurwa.Pakutanga, mutumbi weC2 vertebral wakanga wakamira uye 50 ml yemutsara wakasiyana wakaiswa jekiseni kuti iite nzvimbo yakarurama vertebral artery uye kuronga nzira yekuwana.Zvadaro, 11-gauge introducer tsono yakasimudzirwa kusvika kune imwe nzvimbo-yepakati yemuviri we vertebral kubva kurudyi posterolateral nzira (Fig. 2a).A curved Stryker TroFlex® tsono yakabva yaiswa (Fig. 3) uye yakaiswa muchikamu chepasi chepakati cheC2 osteolytic lesion (Fig. 2b).Polymethyl methacrylate (PMMA) bone simenti yakagadzirwa maererano nemirairo yakajairika.Panguva iyi, pasi penguva CT-fluoroscopic kudzora, pfupa simende akanga jekiseni kuburikidza curved tsono (Fig. 2c).Kamwe kuzadza kwakakwana kwechikamu chezasi chechirwere chakawanikwa, tsono yacho yakabviswa zvishoma uye yakatenderedzwa kuti iwane nzvimbo yepamusoro yepakati-lesion (Fig. 2d).Iko hakuna kuramba kune tsono repositioning sezvo chironda ichi chakanyanya osteolytic lesion.Jekiseni imwe PMMA simende pamusoro peronda.Chengetedzo yakatorwa kudzivirira kubuda kwebhonzo simende mugomba remusana kana paravertebral soft tissues.Mushure mekuwana kuzadzwa kunogutsa nesamende, tsono yakakombama yakabviswa.Postoperative imaging yakaratidza kubudirira PMMA bone sement vertebroplasty (Mifananidzo 2e, 2f).Kuongorora kwepashure kwetsinga kwakaratidza kuti hapana chakakanganisika.Mazuva mashoma gare gare murwere akabudiswa nekervical collar.Marwadzo ake, kunyange zvazvo asina kunyatsopedzwa, akadzorwa zviri nani.Murwere akafa zvinosiririsa mwedzi mishoma abuda muchipatara nekuda kwekunetseka kwegomarara repancreatic.
Computed tomography (CT) mifananidzo inoratidza ruzivo rwekuita.A) Pakutanga, 11 gauge yekunze cannula yakaiswa kubva kune yakarongwa yakarurama posterolateral nzira.B) Kupinzwa kwetsono yakakombama (kaviri museve) kuburikidza necannula (museve mumwechete) muronda.Musoro wetsono unoiswa pasi uye zvakanyanya pakati.C) Polymethyl methacrylate (PMMA) simenti yakaiswa pasi pechironda.D) Iyo tsono yakakotama inodzoserwa uye inopinzwazve muchikamu chepamusoro chepakati, uye ipapo simende yePMMA inobaiwa.E) uye F) kuratidza kugoverwa kwePMMA simenti mushure mekurapa mu coronal uye sagittal ndege.
Vertebral metastases inowanzoonekwa muzamu, prostate, mapapu, thyroid, masero eitsvo, dundira, uye melanoma, ine chiitiko chakaderera cheskeletal metastases kubva ku5 kusvika ku20% mukenza yepancreatic [6,7].Cervical kubatanidzwa mukenza yepancreatic kunyange isingawanzoitiki, ine zviitiko zvina chete zvinorondedzerwa mumabhuku, kunyanya avo vanobatana neC2 [8-11].Kubatanidzwa kwemusana kunogona kunge kusina zviratidzo, asi kana kukabatanidzwa nekuputsika, kunogona kutungamirira kumarwadzo asingadzorwi uye kusagadzikana izvo zvakaoma kudzora nematanho ekuchengetedza uye zvinogona kutungamirira murwere kumutsipa wepelinha.Nokudaro, vertebroplasty isarudzo yekugadzikana kwepelinha uye inosanganiswa nekununurwa kwemarwadzo mune vanopfuura 80% yevarwere vari kutora nzira iyi [12].
Kunyangwe maitiro acho achigona kuitwa zvinobudirira padanho reC2, iyo yakaoma anatomy inogadzira matambudziko ehunyanzvi uye anogona kukonzera matambudziko.Kune dzakawanda neurovascular structures dziri pedyo neC2, sezvo iri anterior kune pharynx uye larynx, lateral kune carotid space, posterolateral kune vertebral artery uye cervical nerve, uye shure kune sac [13].Parizvino, nzira ina dzinoshandiswa muPVP: anterolateral, posterolateral, transoral, uye shanduro.Iyo anterolateral nzira inowanzoitwa munzvimbo yepamusoro uye inoda hyperextension yemusoro kusimudza mandible uye kuita kuti C2 iwane.Nokudaro, nzira iyi inogona kunge isina kukodzera kune varwere vasingakwanisi kuchengetedza musoro hyperextension.Iyo tsono inopfuudzwa nepakati peparapharyngeal, retropharyngeal uye prevertebral nzvimbo uye posterolateral chimiro che carotid artery sheath inonyatso shandiswa nemaoko.Nemaitiro aya, kukuvadzwa kune vertebral artery, carotid artery, jugular vein, submandibular gland, oropharyngeal uye IX, X uye XI cranial nerves zvinogoneka [13].Cerebellar infarction uye C2 neuralgia yechipiri kune simenti inoputika inoonekwawo sematambudziko [14].Nzira yeposterolateral haidi kuti anesthesia yakawanda, inogona kushandiswa kune varwere vasingakwanisi kuwedzera mitsipa, uye inowanzoitwa panzvimbo yepamusoro.Iyo tsono inopfuudzwa kuburikidza nechekumashure cervical space mune anterior, cranial uye medial directions, ichiedza kusabata vertebral artery uye yemukadzi wayo.Nokudaro, zvinetso zvinosanganiswa nekukuvadza kune vertebral artery uye musana wepinini [15].Transoral kupinda mune tekinoroji kushoma uye kunosanganisira kuiswa kwetsono mumadziro epharyngeal uye pharyngeal space.Mukuwedzera kune zvinogona kukuvadza kune vertebral arteries, nzira iyi inobatanidza nehuwandu hwehutachiwana hwehutachiona uye zvinetso zvakadai se pharyngeal abscesses uye meningitis.Iyi nzira inodawo general anesthesia uye intubation [13,15].Nekusvika kwekupedzisira, tsono inopindirwa munzvimbo inogona kuitika pakati pemasheti e-carotid artery uye vertebral artery lateral kusvika pamwero weC1-C3, nepo njodzi yekukuvadza kumidziyo mikuru yakakwirira [13].Chinetso chinogoneka cheimwe nzira ndeyekudonha kwebone simenti, izvo zvinogona kutungamirira mukumanikidzwa kwemutsipa wepelinha kana nerve midzi [16].
Izvo zvave zvichicherechedzwa kuti kushandiswa kwetsono yakakombama mumamiriro ezvinhu aya kune zvimwe zvakanakira, kusanganisira kuwedzera kwese kuchinjika kuchinjika uye tsono maneuverability.Iyo tsono yakakomberedzwa inobatsira kune: kugona kusarudza zvakanangana zvikamu zvakasiyana zvemuviri wevertebral, yakavimbika midline kupinza, kuderedzwa kwemaitiro nguva, kuderedzwa simende yekudonha chiyero, uye yakaderedzwa fluoroscopy nguva [4,5].Kubva pakuongorora kwedu kwezvinyorwa, kushandiswa kwetsono dzakakombama mumutsipa wekervical hakuna kutaurwa, uye mumatambudziko ari pamusoro apa, tsono dzakatwasuka dzakashandiswa posterolateral vertebroplasty paC2 level [15,17-19].Zvichipa iyo yakaoma anatomy yenharaunda yemutsipa, iyo yakawedzera maneuverability yeyakakombama tsono nzira inogona kunyanya kubatsira.Sezvinoratidzwa munyaya yedu, kuvhiyiwa kwakaitwa munzvimbo yakasununguka uye takashandura nzvimbo yetsono kuzadza zvikamu zvakawanda zveronda.Mune imwe nyaya ichangobva kuitika, Shah et al.Iyo tsono yakakombama yakasara mushure mebharumu kyphoplasty yakafumurwa zvechokwadi, zvichiratidza kuti kungangove kunetsa kwetsono yakakombama: chimiro chetsono chinogona kuita kuti kubviswa kwayo [20].
Muchirevo chechinyorwa chino, tinoratidza kurapa kwakabudirira kwekusagadzikana kwepathological fractures yeC2 vertebral body uchishandisa posterolateral PVP ine curved tsono uye intermittent CT fluoroscopy, zvichiita kuti kuputsika kugadzikane uye kugadzirisa marwadzo.Nzira yetsono yakakomberedzwa inobatsira: inotibvumira kusvika kune chironda kubva kune yakachengeteka posterolateral nzira uye inotibvumira kutungamirira tsono kune zvikamu zvose zvechirwere uye zvakakwana uye zvakakwana kuzadza chironda nePMMA simenti.Tinotarisira kuti nzira iyi inogona kuderedza kushandiswa kweanesthesia inodiwa kuti transoropharyngeal kuwana uye kudzivisa matambudziko eurourovascular akabatanidzwa neanterior and lateral approaches.
Zvidzidzo Zvevanhu: Vese vakapinda muchidzidzo ichi vakapa kana kusapa mvumo.Kupesana Kwekufarira: Maererano neICMJE Uniform Disclosure Form, vanyori vose vanozivisa zvinotevera: Kubhadhara / Ruzivo Rwebasa: Vese vanyori vanotaura kuti havana kuwana rubatsiro rwemari kubva kune chero sangano rebasa rakatumirwa.Hukama Hwemari: Vese vanyori vanozivisa kuti ivo parizvino kana mukati memakore matatu apfuura vane hukama hwemari nechero sangano rinogona kufarira basa rakatumirwa.Humwe Hukama: Vese vanyori vanotaura kuti hapana humwe hukama kana zviitiko zvinogona kukanganisa basa rakatumirwa.
Swarnkar A, Zane S, Christie O, nevamwe.(Chivabvu 29, 2022) Vertebroplasty yepathological C2 fractures: yakasarudzika kiriniki kesi uchishandisa yakakombama tsono nzira.Kurapa 14(5): e25463.doi:10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Ichi chinyorwa chekupinda chakavhurika chakagoverwa pasi pemitemo yeCreative Commons Attribution License CC-BY 4.0.Kushandiswa kusingagumi, kugovera, uye kubereka mune chero svikiro zvinotenderwa, chero munyori wekutanga uye kwakabva vatenda.
Ichi chinyorwa chekupinda chakavhurika chakagoverwa pasi peCreative Commons Attribution License, iyo inobvumidza kushandiswa kusingarambidzwe, kugovera, uye kubereka mune chero svikiro, chero munyori uye kwaanopihwa.
Panel A inoratidza zvakasiyana uye cortical irregularities (miseve) kurudyi anterior side yeC2 vertebral body.Asymmetric kuwedzera kwekurudyi atlantiaxial joint uye cortical irregularity paC2 (museve wakakora, B).Izvi, pamwe chete nekujeka kwehuwandu kune rumwe rutivi rworudyi rweC2, zvinoratidza kuparara kwepathological.
Computed tomography (CT) mifananidzo inoratidza ruzivo rwekuita.A) Pakutanga, 11 gauge yekunze cannula yakaiswa kubva kune yakarongwa yakarurama posterolateral nzira.B) Kupinzwa kwetsono yakakombama (kaviri museve) kuburikidza necannula (museve mumwechete) muronda.Musoro wetsono unoiswa pasi uye zvakanyanya pakati.C) Polymethyl methacrylate (PMMA) simenti yakaiswa pasi pechironda.D) Iyo tsono yakakotama inodzoserwa uye inopinzwazve muchikamu chepamusoro chepakati, uye ipapo simende yePMMA inobaiwa.E) uye F) kuratidza kugoverwa kwePMMA simenti mushure mekurapa mu coronal uye sagittal ndege.
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