“Ungalokothi ungabaze ukuthi iqembu elincane lezakhamuzi ezicabangayo nezizinikele lingawushintsha umhlaba.Eqinisweni, iyona yodwa ekhona.”
Umgomo kaCureus uwukushintsha imodeli yakudala yokushicilelwa kwezokwelapha, lapho ukuthunyelwa kocwaningo kungase kubize, kube nzima, futhi kudle isikhathi.
I-Neuroradiology, ukudluliswa komgogodla, i-vertebroplasty yomlomo wesibeletho, indlela ye-posterolateral, inaliti egobile, i-neuroradiology ye-interventional, i-vertebroplasty ye-percutaneous
Calula lesi sihloko ngokuthi: Swarnkar A, Zain S, Christie O, et al.(Meyi 29, 2022) I-Vertebroplasty yokuphuka kwe-C2 ye-pathological: ikesi lomtholampilo elihlukile lisebenzisa indlela yenaliti egobile.Ukwelapha 14(5): e25463.doi:10.7759/cureus.25463
I-vertebroplasty ehlasela kancane iye yavela njengendlela yokwelapha ehlukile yokuphuka kwama-vertebral.I-Vertebroplasty ibhalwe kahle endleleni ye-thoracic kanye ne-lumbar posterolateral, kodwa akuvamile ukusetshenziselwa umgogodla womlomo wesibeletho ngenxa yezakhiwo eziningi ezibalulekile ze-neural ne-vascular okufanele zigwenywe.Ukusetshenziswa kwesu lokucophelela kanye nezithombe kubalulekile ukuze kusetshenziswe izakhiwo ezibucayi futhi kuncishiswe ubungozi bezinkinga.Ngendlela ye-posterolateral, i-lesion kufanele ibekwe endaweni eqondile yenaliti ye-trajectory lateral kuya ku-vertebra ye-C2.Le ndlela ingase inciphise ukwelashwa okwanele kwezilonda ezisezindaweni ezimaphakathi.Sichaza icala lomtholampilo eliyingqayizivele lendlela ephumelelayo nephephile ye-posterolateral yokwelashwa kwama-metastases e-C2 abhubhisayo aphakathi kusetshenziswa inaliti egobile.
I-Vertebroplasty ihilela ukushintshwa kwezinto zangaphakathi zomzimba we-vertebral ukulungisa ukuphuka noma ukungazinzi kwesakhiwo.Usimende uvame ukusetshenziswa njengento yokupakisha, okuholela ekwandiseni amandla e-vertebrae, ingozi encishisiwe yokuwa, nokunciphisa ubuhlungu, ikakhulukazi ezigulini ezine-osteoporosis noma i-osteolytic bone lesions [1].I-Percutaneous vertebroplasty (PVP) ivame ukusetshenziswa njenge-adjunct kuma-analgesics kanye nokwelapha ngemisebe ukuze kudambise ubuhlungu ezigulini ezine-vertebral fractures yesibili kuya ebuhlungu.Le nqubo ivame ukuqhutshwa emgodleni we-thoracic kanye ne-lumbar ngokusebenzisa i-posterolateral pedicle noma indlela ye-extrapedicular.I-PVP ngokuvamile ayenziwa emgodleni womlomo wesibeletho ngenxa yobukhulu obuncane bomzimba we-vertebral kanye nezinkinga zobuchwepheshe ezihlobene nokuba khona kwezakhiwo ezibalulekile ze-neurovascular emgodleni womlomo wesibeletho njengomgogodla, i-carotid arteries, i-jugular veins, ne-cranial nerves.2].I-PVP, ikakhulukazi ezingeni le-C2, ayivamile uma kuqhathaniswa noma ayivamile ngenxa yenkimbinkimbi ye-anatomical kanye nokubandakanyeka kwesimila ezingeni le-C2.Endabeni yezilonda ze-osteolytic ezingazinzile, i-vertebroplasty ingenziwa uma inqubo ithathwa njengeyinkimbinkimbi kakhulu.Ezilonda ze-PVP zemizimba ye-vertebral ye-C2, inaliti eqondile ivame ukusetshenziswa kusukela ku-anterolateral, posterolateral, translational, noma transoral (pharyngeal) indlela yokugwema izakhiwo ezibucayi [3].Ukusetshenziswa kwenaliti eqondile kubonisa ukuthi isilonda kufanele silandele lo mzila wokuphulukisa okwanele.Izilonda ezingaphandle komzila oqondile zingase zibangele ukwelashwa okulinganiselwe, okunganele noma ukukhishwa ngokuphelele ekwelashweni okufanele.Inqubo ye-PVP yenaliti egobile isanda kusetshenziswa emgogodleni we-lumbar kanye ne-thoracic ngemibiko yokwenyuka kokuhamba [4,5].Kodwa-ke, ukusetshenziswa kwezinaliti ezigobile emgogodleni womlomo wesibeletho akubikwanga.Sichaza isimo somtholampilo sokuphuka kwe-C2 okungavamile kwe-pathologic yesibili kuya kumdlavuza we-metastatic pancreatic olashwe nge-PVP yomlomo wesibeletho yangemuva.
Indoda eneminyaka engu-65 ubudala yethulwe esibhedlela izinhlungu ezisanda kuvela ehlombe langakwesokudla nasentanyeni ephikelele izinsuku ezingu-10 ngaphandle kokuthola impumuzo ngemithi ethengwayo.Lezi zimpawu azihlotshaniswa nanoma yikuphi ukuba ndikindiki noma ubuthakathaka.Wayenomlando obalulekile womdlavuza we-pancreatic ongahlukanisiwe kahle we-metastatic, i-arterial hypertension kanye notshwala obunzima.Uqede imijikelezo ye-6 ye-FOLFIRINOX (i-leucovorin/leucovorin, i-fluorouracil, i-irinotecan hydrochloride ne-oxaliplatin) kodwa waqala uhlobo olusha lwe-gemzar ne-abraxane emasontweni amabili edlule ngenxa yokuqhubeka kwesifo.Ekuhlolweni komzimba, wayengenalo isisa ekushayeni umlomo wesibeletho, i-thoracic, noma i-lumbar spine.Ngaphezu kwalokho, kwakungekho ukukhubazeka kwezinzwa kanye nezimoto emaphethelweni aphezulu naphansi.Ukukhalipha kwakhe kwamazwe amabili kwakujwayelekile.Iskena esingaphandle kwesibhedlela se-computed tomography (CT) somgogodla womlomo wesibeletho sabonisa izilonda ze-osteolytic ezihambisana nesifo se-metastatic esibandakanya uhlangothi lwesokudla lomzimba we-C2 we-vertebral, isisindo esilungile se-C2, ipuleti le-vertebral eliseduze, kanye nohlangothi olucindezelekile lwe-C2. .I-articular surface block engaphezulu kwesokudla (Fig. 1).I-neurosurgeon kuboniswane nayo, i-imaging magnetic resonance (MRI) yomgogodla wesibeletho, i-thoracic kanye ne-lumbar yenziwa, kucatshangelwa izilonda ze-metastatic osteolytic.Okutholwe yi-MRI kubonise i-T2 hyperintensity, i-T1 isointense izicubu ezithambile ezithatha indawo yesokudla somzimba we-C2 vertebral, ngokusatshalaliswa okulinganiselwe kanye nokuthuthukiswa kokugqama kwangemuva.Wathola ukwelashwa ngemisebe ngaphandle kokuthuthuka okubonakalayo ezinhlungwini.Isevisi ye-neurosurgery incoma ukuthi kungenziwa ukuhlinzwa okuphuthumayo.Ngakho-ke, i-radiology yokungenelela (IR) yayidingeka ukuze uthole ukwelashwa okwengeziwe ngenxa yobuhlungu obunzima kanye nengozi yokungazinzi kanye nokucindezelwa komgogodla okungenzeka.Ngemuva kokuhlolwa, kunqunywe ukwenza i-CT-guided percutaneous C2 spine plasty usebenzisa indlela ye-posterolateral.
Iphaneli A libonisa ukungahambi kahle okuhlukile kanye ne-cortical (imicibisholo) ngakwesokudla sangaphambili somzimba we-vertebral C2.Ukunwetshwa kwe-asymmetric yelunga elilungile le-atlantiaxial kanye nokungalungi kwekhohlo ku-C2 (umcibisholo owugqinsi, B).Lokhu, kanye nokubonakala kwesisindo ngakwesokudla kwe-C2, kubonisa ukuphuka kwe-pathological.
Isiguli sibekwe ohlangothini lwesokunene sokulala futhi i-2.5 mg ye-Versed kanye ne-125 μg ye-fentanyl inikezwe ngezilinganiso ezihlukanisiwe.Ekuqaleni, umzimba we-vertebral we-C2 wawubekwe futhi i-50 ml yokuhluka kwe-intravenous yajova ukuze kwenziwe indawo yomthambo we-vertebral olungile futhi ihlele umzila wokufinyelela.Khona-ke, inaliti yesingeniso ye-11-gauge yathuthukiswa engxenyeni yangemuva-ephakathi yomzimba we-vertebral kusukela endleleni efanele ye-posterolateral (Fig. 2a).Inaliti ye-Stryker TroFlex® egobile yabe ifakwa (Fig. 3) futhi yafakwa engxenyeni ephansi ye-medial ye-C2 lesion osteolytic (Fig. 2b).I-Polymethyl methacrylate (PMMA) usimende wamathambo walungiswa ngokuvumelana neziqondiso ezijwayelekile.Kulesi sigaba, ngaphansi kokulawulwa kwe-CT-fluoroscopic ngezikhathi ezithile, usimende wethambo wajovwa ngenaliti egobile (Fig. 2c).Uma ukugcwaliswa okwanele kwengxenye engezansi ye-lesion kufinyelelwe, inaliti yahoxiswa kancane futhi yajikeleza ukuze ifinyelele indawo ephezulu ye-lesion ephakathi (Fig. 2d).Akukho ukumelana nokubekwa kabusha kwenaliti njengoba lesi silonda siyisilonda esibi se-osteolytic.Faka usimende owengeziwe we-PMMA phezu kwesilonda.Kwathathwa ukunakekelwa ukuze kugwenywe ukuvuza kukasimende wethambo emseleni womgogodla noma izicubu ezithambile ze-paravertebral.Ngemva kokufeza ukugcwaliswa okwanelisayo ngosimende, inaliti egobile yasuswa.I-postoperative imaging ibonise i-PMMA ephumelelayo yethambo le-cement vertebroplasty (Izibalo 2e, 2f).Ukuhlolwa kwezinzwa kwangemva kokuhlinzwa akuvezanga kulimala.Ezinsukwini ezimbalwa kamuva isiguli sakhishwa ngekhola yomlomo wesibeletho.Ubuhlungu bakhe, nakuba bungazange buxazululwe ngokuphelele, babulawuleka kangcono.Isiguli sashona kabuhlungu ezinyangeni ezimbalwa ngemuva kokuphuma esibhedlela ngenxa yezinkinga zomdlavuza we-pancreatic.
Izithombe ze-Computed tomography (CT) ezibonisa imininingwane yenqubo.A) Ekuqaleni, i-cannula yangaphandle ye-gauge engu-11 yafakwa kusukela endleleni ehleliwe engemuva kwesokudla.B) Ukufakwa kwenaliti egobile (umcibisholo okabili) ku-cannula (umcibisholo owodwa) endaweni yesilonda.Isihloko senaliti sibekwe ngaphansi nangaphezulu.C) Usimende we-Polymethyl methacrylate (PMMA) wajovwa ngaphansi kwesilonda.D) Inaliti egobile iyahoxiswa futhi iphinde ifakwe ohlangothini oluphakathi oluphakeme, bese kujovwa usimende we-PMMA.E) kanye no-F) zibonisa ukusatshalaliswa kukasimende we-PMMA ngemva kokwelashwa ezindizeni ze-coronal ne-sagittal.
I-Vertebral metastases ivame ukubonakala ebeleni, i-prostate, iphaphu, i-thyroid, amangqamuzana ezinso, isinye, ne-melanoma, enezinga eliphansi le-skeletal metastases kusuka ku-5 kuya ku-20% kumdlavuza we-pancreatic [6,7].Ukubandakanyeka komlomo wesibeletho kumdlavuza we-pancreatic kungavamile nakakhulu, ngamacala amane kuphela abikwe ezincwadini, ikakhulukazi lawo ahlotshaniswa ne-C2 [8-11].Ukubandakanyeka komgogodla kungase kungabonakali, kodwa uma kuhlangene nokuphuka, kungabangela ubuhlungu obungalawuleki nokungazinzi okunzima ukulawula ngezinyathelo zokulondoloza futhi kungase kubangele isiguli ekucindezelweni komgogodla.Ngakho-ke, i-vertebroplasty iyindlela yokukhetha ukuzinza komgogodla futhi ihlotshaniswa nokukhululeka kobuhlungu ngaphezu kwe-80% yeziguli ezenza le nqubo [12].
Nakuba inqubo ingenziwa ngempumelelo ezingeni le-C2, i-anatomy eyinkimbinkimbi idala ubunzima bezobuchwepheshe futhi ingase iholele ezinkingeni.Kunezakhiwo eziningi ze-neurovascular eziseduze ne-C2, njengoba ingaphambili ku-pharynx kanye ne-larynx, i-lateral endaweni ye-carotid, i-posterolateral kumthambo we-vertebral kanye ne-nerve yomlomo wesibeletho, futhi ngemuva kwesaka [13].Njengamanje, kusetshenziswe izindlela ezine ku-PVP: i-anterolateral, i-posterolateral, i-transoral, neyokuhumusha.Indlela ye-anterolateral ivame ukuqhutshwa endaweni ephansi futhi idinga i-hyperextension yekhanda ukuze kuphakanyiswe i-mandible nokwenza lula ukufinyelela kwe-C2.Ngakho-ke, le nqubo ingase ingafaneleki ezigulini ezingakwazi ukugcina i-hyperextension yekhanda.Inaliti idlula ezindaweni ze-parapharyngeal, retropharyngeal kanye ne-prevertebral futhi isakhiwo se-posterolateral se-carotid artery sheath siphathwa ngokucophelela ngesandla.Ngale ndlela, ukulimala komthambo we-vertebral, umthambo we-carotid, i-jugular vein, i-submandibular gland, i-oropharyngeal ne-IX, i-X kanye ne-XI ye-cranial nerves kungenzeka [13].I-Cerebellar infarction kanye ne-C2 neuralgia yesibili yokuvuza kukasimende nayo ibhekwa njengezinkinga [14].Indlela ye-posterolateral ayidingi i-anesthesia ejwayelekile, ingasetshenziswa ezigulini ezingakwazi ukukhulisa intamo, futhi ngokuvamile yenziwa endaweni yokulala.Inaliti idluliswa endaweni yangemuva yomlomo wesibeletho endaweni yangaphambili, ye-cranial kanye ne-medial, uzama ukuthi ungathinti umthambo we-vertebral kanye nesitho sangasese sowesifazane.Ngakho-ke, izinkinga zihlotshaniswa nokulimala komthambo we-vertebral kanye nentambo yomgogodla [15].Ukufinyelela kwe-transoral akulula ngokobuchwepheshe futhi kuhilela ukwethulwa kwenaliti odongeni lwepharyngeal kanye nesikhala sepharyngeal.Ngaphandle kokulimala okungenzeka emithanjeni ye-vertebral, le ndlela ihlotshaniswa nengozi enkulu yokutheleleka kanye nezinkinga ezifana namathumba e-pharyngeal kanye ne-meningitis.Le ndlela idinga i-anesthesia ejwayelekile kanye ne-intubation [13,15].Ngokufinyelela kwe-lateral, inaliti ifakwa esikhaleni esingaba khona phakathi kwama-sheath of the artery carotid kanye ne-vertebral artery lateral kuya ezingeni le-C1-C3, kuyilapho ingozi yokulimala kwemikhumbi eyinhloko iphakeme [13].Inkinga engenzeka yanoma iyiphi indlela ukuvuza kukasimende wamathambo, okungaholela ekucindezelweni komgogodla noma izimpande zezinzwa [16].
Kuye kwaphawulwa ukuthi ukusetshenziswa kwenaliti egobile kulesi simo kunezinzuzo ezithile, okubandakanya ukwanda kokuguquguquka kokufinyeleleka okuphelele kanye nokuhamba kwezinaliti.Inaliti egobile ifaka isandla kulokhu: ikhono lokukhetha ngokukhetha izingxenye ezihlukene zomzimba we-vertebral, ukungena okuthembekile komugqa omaphakathi, isikhathi esincishisiwe senqubo, ukunciphisa izinga lokuvuza kukasimende, nokunciphisa isikhathi se-fluoroscopy [4,5].Ngokusekelwe ekubuyekezeni kwethu izincwadi, ukusetshenziswa kwezinaliti ezigobile emgodleni womlomo wesibeletho akuzange kubikwe, futhi ezimweni ezingenhla, izinaliti eziqondile zazisetshenziselwa i-vertebroplasty ye-posterolateral ezingeni le-C2 [15,17-19].Njengoba kunikezwe i-anatomy eyinkimbinkimbi yesifunda sentamo, ukuhamba okukhulayo kwendlela yenaliti egobile kungase kube nenzuzo ngokukhethekile.Njengoba kuboniswe esimweni sethu, ukuhlinzwa kwenziwa endaweni ekhululekile ehlangothini futhi sashintsha indawo yenaliti ukuze sigcwalise izingxenye eziningana zesilonda.Embikweni wakamuva wecala, u-Shah et al.Inaliti egobile eshiywe ngemuva kwe-balloon kyphoplasty idalulwe ngempela, okuphakamisa inkinga engase ibe khona yenaliti egobile: ukwakheka kwenaliti kungenza kube lula ukususwa kwayo [20].
Kulo mongo, sibonisa ukwelashwa okuphumelelayo kokuqhekeka okungazinzile kwe-pathological fractures ye-C2 yomzimba we-vertebral usebenzisa i-posterolateral PVP enenaliti egobile kanye ne-CT fluoroscopy, okuholela ekuqineni kokuphuka nokulawula ubuhlungu obuthuthukisiwe.Inqubo yenaliti egobile iyinzuzo: isivumela ukuthi sifinyelele isilonda sisuka endleleni ephephile ye-posterolateral futhi isivumela ukuthi siqondise kabusha inaliti kuzo zonke izici zesilonda futhi sigcwalise ngokwanele futhi ngokugcwele isilonda ngosimende we-PMMA.Silindele ukuthi le nqubo ingase ikhawulele ukusetshenziswa kwe-anesthesia edingekayo ekufinyeleleni kwe-transoropharyngeal futhi igweme izinkinga ze-neurovascular ezihambisana nezindlela zangaphambili nezingemuva.
Izifundo Zabantu: Bonke ababambiqhaza kulolu cwaningo banikeze noma abazange banikeze imvume.Ukungqubuzana Kwezintshisekelo: Ngokuhambisana nefomu le-ICMJE Lokudalula Okufanayo, bonke ababhali bamemezela lokhu okulandelayo: Ulwazi Lokukhokha/ Lwesevisi: Bonke ababhali bamemezela ukuthi abatholanga ukwesekwa kwezezimali kunoma iyiphi inhlangano ngomsebenzi othunyelwe.Ubudlelwano Bezezimali: Bonke ababhali bamemezela ukuthi okwamanje noma phakathi neminyaka emithathu edlule abanabo ubudlelwano bezezimali nanoma iyiphi inhlangano engase ibe nentshisekelo emsebenzini othunyelwe.Obunye Ubudlelwano: Bonke ababhali bamemezela ukuthi abukho obunye ubudlelwano noma imisebenzi engathinta umsebenzi othunyelwe.
Swarnkar A, Zane S, Christie O, et al.(Meyi 29, 2022) I-Vertebroplasty yokuphuka kwe-C2 ye-pathological: ikesi lomtholampilo elihlukile lisebenzisa indlela yenaliti egobile.Ukwelapha 14(5): e25463.doi:10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Lena indatshana yokufinyelela evulekile esatshalaliswa ngaphansi kwemigomo ye-Creative Commons Attribution License CC-BY 4.0.Ukusetshenziswa okungenamkhawulo, ukusatshalaliswa, kanye nokukhiqizwa kabusha kunoma iyiphi indlela kuvunyelwe, inqobo nje uma umlobi wangempela kanye nomthombo kwaziswa.
Lesi isiqephu sendatshana esivulekile sokufinyelela esatshalaliswa ngaphansi kwe-Creative Commons Attribution License, evumela ukusetshenziswa okungakhawulelwe, ukusatshalaliswa, kanye nokukhiqizwa kabusha kunoma iyiphi indlela, inqobo nje uma umbhali nomthombo kufakwe ikhredithi.
Iphaneli A libonisa ukungahambi kahle okuhlukile kanye ne-cortical (imicibisholo) ngakwesokudla sangaphambili somzimba we-vertebral C2.Ukunwetshwa kwe-asymmetric yelunga elilungile le-atlantiaxial kanye nokungalungi kwekhohlo ku-C2 (umcibisholo owugqinsi, B).Lokhu, kanye nokubonakala kwesisindo ngakwesokudla kwe-C2, kubonisa ukuphuka kwe-pathological.
Izithombe ze-Computed tomography (CT) ezibonisa imininingwane yenqubo.A) Ekuqaleni, i-cannula yangaphandle ye-gauge engu-11 yafakwa kusukela endleleni ehleliwe engemuva kwesokudla.B) Ukufakwa kwenaliti egobile (umcibisholo okabili) ku-cannula (umcibisholo owodwa) endaweni yesilonda.Isihloko senaliti sibekwe ngaphansi nangaphezulu.C) Usimende we-Polymethyl methacrylate (PMMA) wajovwa ngaphansi kwesilonda.D) Inaliti egobile iyahoxiswa futhi iphinde ifakwe ohlangothini oluphakathi oluphakeme, bese kujovwa usimende we-PMMA.E) kanye no-F) zibonisa ukusatshalaliswa kukasimende we-PMMA ngemva kokwelashwa ezindizeni ze-coronal ne-sagittal.
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