“Ya adịla mgbe obi abụọ adịghị ya na obere ìgwè ụmụ amaala nwere echiche, raara onwe ha nye pụrụ ịgbanwe ụwa.N'ezie, ọ bụ naanị ya ebe ahụ.”
Ọrụ Cureus bụ ịgbanwe usoro mbipụta ahụike ogologo oge, nke ntinye nyocha nwere ike ịdị oke ọnụ, mgbagwoju anya ma na-ewe oge.
Neuroradiology, nnyefe vertebral, cervical vertebroplasty, posterolateral obibia, agịga agbagọ, neuroradiology ntinye aka, percutaneous vertebroplasty
Kpọtụrụ akụkọ a dịka: Swarnkar A, Zain S, Christie O, et al.(May 29, 2022) Vertebroplasty maka mgbaji C2 pathological: ikpe ụlọ ọgwụ pụrụ iche na-eji usoro agịga agbagọ.Ọgwụgwọ 14 (5): e25463.doi:10.7759/cureus.25463
Vertebroplasty pere mpe apụtala dị ka ọgwụgwọ ọzọ nwere ike ime maka mgbaji vertebral pathological.A na-edepụta vertebroplasty nke ọma na usoro thoracic na lumbar posterolateral, ma a na-ejikarị ya eme ihe na spine cervical n'ihi ọtụtụ ihe dị mkpa na-ahụ maka akwara na vaskụla nke kwesịrị izere.Iji usoro nlezianya na onyonyo dị mkpa iji megharịa ihe owuwu dị oke egwu ma belata ihe egwu nke nsogbu.N'ihe na-aga n'ihu, ọnya ahụ kwesịrị ịdị na-adị na trajectory agịga kwụ ọtọ n'akụkụ C2 vertebra.Ụzọ a nwere ike igbochi ọgwụgwọ zuru oke nke ọnya dị n'etiti etiti.Anyị na-akọwa ihe gbasara ụlọ ọgwụ pụrụ iche nke ụzọ ga-aga nke ọma ma dị mma posterolateral maka ọgwụgwọ nke medial C2 metastases na-emebi emebi site na iji agịga gbagọrọ agbagọ.
Vertebroplasty na-agụnye ngbanwe nke ihe dị n'ime ahụ nke vertebral ahụ iji mezie mgbaji ma ọ bụ nkwụsị nhazi.A na-ejikarị ciment eme ihe dị ka ihe nkwakọba ihe, na-eme ka ike nke vertebrae dịkwuo ike, belata ihe ize ndụ nke ịdaba, na mbelata mgbu, karịsịa na ndị ọrịa nwere ọkpụkpụ ọkpụkpụ ma ọ bụ ọkpụkpụ ọkpụkpụ ọkpụkpụ [1].A na-ejikarị percutaneous vertebroplasty (PVP) eme ihe dị ka ihe mgbakwunye na analgesics na ọgwụgwọ radieshon iji wepụ ihe mgbu na ndị ọrịa nwere ọkpụkpụ vertebral nke abụọ na-adịghị mma.A na-emekarị usoro a na thoracic na spine lumbar site na pedicle posterolateral ma ọ bụ ụzọ extrapedicular.A naghị emekarị PVP na spine cervical n'ihi obere akụkụ nke vertebral ahụ na nsogbu nkà na ụzụ metụtara ọnụnọ nke akụkụ dị mkpa nke neurovascular na spine cervical dị ka ọkpụkpụ azụ, carotid arteries, veins jugular, na akwara cranial.2].PVP, karịsịa na ọkwa C2, dị obere ma ọ bụ ọbụna dị ụkọ n'ihi mgbagwoju anya anatomical na etuto aka na ọkwa C2.N'ihe banyere ọnya osteolytic na-adịghị akwụsi ike, enwere ike ịme vertebroplasty ma ọ bụrụ na a na-ewere usoro ahụ dị mgbagwoju anya.Na ọnya PVP nke akụkụ vertebral C2, a na-ejikarị agịga kwụ ọtọ site na anterolateral, posterolateral, translational, or transoral (pharyngeal) iji zere ihe owuwu dị oke mkpa [3].Iji agịga kwụ ọtọ na-egosi na ọnya ahụ ga-agbaso ọnọdụ a maka ọgwụgwọ zuru oke.Ọnya dị n'èzí n'ụzọ ziri ezi nwere ike ịkpata oke, ọgwụgwọ ezughị oke ma ọ bụ nkwụsị zuru oke na ọgwụgwọ kwesịrị ekwesị.A na-eji usoro PVP agịga gbagọrọ agbagọ n'oge na-adịbeghị anya na lumbar na thoracic spain na akụkọ banyere mmụba dị ukwuu [4,5].Otú ọ dị, a kọpụtabeghị iji agịga gbagọrọ agbagọ na spain cervical.Anyị na-akọwa ihe gbasara ụlọ ọgwụ nke mgbawa C2 pathologic na-adịghị ahụkebe nke abụọ na ọrịa cancer pancreatic metastatic ejiri PVP cervical na-agwọ ya.
Otu nwoke dị afọ 65 gosipụtara n'ụlọ ọgwụ ahụ ihe mgbu ọhụrụ dị n'ubu aka nri ya na n'olu nke dịgidere ruo ụbọchị 10 na-enweghị ahụ efe site na ọgwụ ndị na-ere ahịa.Agaghị ejikọta ihe mgbaàmà ndị a na nhụjuanya ma ọ bụ adịghị ike ọ bụla.Ọ nwere akụkọ ihe mere eme nke metastatic na-adịghị mma dị iche iche nke ọrịa cancer pancreatic nke IV, ọbara mgbali elu na oke mmanya.Ọ mezuru usoro 6 nke FOLFIRINOX (leucovorin / leucovorin, fluorouracil, irinotecan hydrochloride na oxaliplatin) ma malite usoro ọhụrụ nke gemzar na abraxane izu abụọ gara aga n'ihi ọganihu ọrịa.Na nyocha anụ ahụ, ọ nweghị mmetụta dị nro na palpation nke cervical, thoracic, ma ọ bụ lumbar spain.Tụkwasị na nke ahụ, ọ dịghị ihe mmetụta uche na moto dị n'akụkụ elu na nke ala.Ntụgharị uche nke akụkụ abụọ ya bụ ihe nkịtị.Ihe nyocha CT nke na-apụ apụ n'ụlọ ọgwụ nke spine cervical gosipụtara ọnya osteolytic na-ejikọta ya na ọrịa metastatic gụnyere akụkụ aka nri nke C2 vertebral ahụ, C2 C2 aka nri, efere vertebral aka nri dị n'akụkụ, na akụkụ dara mbà n'obi nke C2. .Ihe mgbochi elu akụkụ aka nri nke elu (Fig 1).Onye neurosurgeon gbara ajụjụ ọnụ, a na-eme ihe ngosi magnetik resonance (MRI) nke cervical, thoracic na lumbar spain, na-eburu n'uche ọnya osteolytic metastatic.Nchọpụta MRI gosipụtara hyperintensity T2, T1 isointense anụ ahụ dị nro na-edochi akụkụ aka nri nke C2 vertebral ahụ, na-enwe oke mgbasa ozi na nkwalite post-contrast.Ọ natara ọgwụgwọ radieshon na-enweghị ọganihu ọ bụla a na-ahụ anya na mgbu.Ọrụ neurosurgical na-atụ aro ka ị ghara ime ịwa ahụ mberede.Ya mere, a chọrọ ka redio ntinye aka (IR) maka ọgwụgwọ ọzọ n'ihi oke mgbu na ihe ize ndụ nke enweghị ike na mkpakọ ọkpụkpụ azụ nwere ike ime.Mgbe nyochachara, e kpebiri ịrụ plasty spine C2 nke na-eduzi CT na-eji usoro posterolateral.
Ogwe A na-egosi mmebi iwu dị iche na cortical (akụ) n'akụkụ aka nri nke C2 vertebral ahụ.Mgbasawanye asymmetric nke nkwonkwo atlantoaxial aka nri na cortical irregularity na C2 (akụ oke, B).Nke a, yana nghọta nke oke n'akụkụ aka nri nke C2, na-egosi mgbawa nke pathological.
A na-etinye onye ọrịa ahụ n'akụkụ aka nri nke ịgha ụgha na 2.5 mg nke Versed na 125 μg nke fentanyl ka a na-enye ya na usoro nkewa.Na mbụ, a na-edobe ahụ C2 vertebral na 50 ml nke ọdịiche dị n'ime intravenous ka a na-agbanye iji wepụta akwara vertebral ziri ezi ma na-eme atụmatụ ohere ịnweta.Mgbe ahụ, a na-ebuli agịga ntinye ihe nke 11 na-aga n'ihu n'azụ-medial nke vertebral ahụ site na ụzọ ziri ezi posterolateral (Fig. 2a).A na-etinyezie agịga Stryker TroFlex® gbagọrọ agbagọ (Fig 3) ma tinye ya na etiti etiti nke C2 osteolytic lesion (Fig 2b).A kwadebere ciment ọkpụkpụ polymethyl methacrylate (PMMA) dịka ntuziaka ọkọlọtọ si dị.N'oge a, n'okpuru nchịkwa CT-fluoroscopic oge, a na-agbanye ciment ọkpụkpụ site na agịga gbagọrọ agbagọ (Fig 2c).Ozugbo e nwetara njuputa zuru oke nke akụkụ ala nke ọnya ahụ, a na-ewepụ agịga ahụ ma gbanwee ka ọ banye n'ọkwa dị elu nke etiti (Fig 2d).Enweghị nguzogide ntugharị agịga n'ihi na ọnya a bụ ọnya osteolytic siri ike.Tinye ciment ọzọ PMMA n'elu ọnya ahụ.A na-elezi anya ka ịzenarị nsị nke ciment ọkpụkpụ n'ime ọwa azụ azụ ma ọ bụ anụ ahụ dị nro nke paravertebral.Mgbe emechara njuputa na-eju afọ na ciment, a na-ewepụ agịga gbagọrọ agbagọ.Onyonyo n'ihu na-egosi ihe ịga nke ọma PMMA ọkpụkpụ ciment vertebroplasty (Figures 2e, 2f).Nnyocha akwara ozi mgbe ịwachara ahụ ekpughere enweghị ntụpọ ọ bụla.Ụbọchị ole na ole ka e mesịrị, a napụrụ onye ọrịa ahụ na olu akwa cervical.Ihe mgbu ya, ọ bụ ezie na a kwụsịbeghị ya kpamkpam, a na-achịkwa ya nke ọma.Onye ọrịa ahụ nwụrụ n'ụzọ dị mwute ọnwa ole na ole ka a chụpụrụ ya n'ụlọ ọgwụ n'ihi nsogbu nke ọrịa cancer pancreatic na-emerụ ahụ.
Ihe onyonyo kọmputa (CT) na-egosi nkọwa nke usoro ahụ.A) Na mbido, etinyere ihe nlere anya 11 dị n'èzí site na ụzọ a na-eme atụmatụ nke ọma posterolateral.B) Ntinye nke agịga gbagọrọ agbagọ (akụ abụọ) site na cannula (otu akụ) n'ime ọnya ahụ.A na-etinye ọnụ ọnụ agịga ahụ ala na karịa n'etiti.C) Polymethyl methacrylate (PMMA) simenti na-agbanye n'ime ala nke ọnya ahụ.D) A na-eweghachi agịga a gbatọrọ agbagọ ma tinyeghachi ya n'akụkụ etiti dị elu, wee gbanye ciment PMMA.E) na F) na-egosi nkesa simenti PMMA mgbe a gwọchara ya na ụgbọ elu coronal na sagittal.
A na-ahụkarị metastases vertebral na ara, prostate, ngụgụ, thyroid, sel akụrụ, eriri afo, na melanoma, yana mbelata nke metastases skeletal sitere na 5 ruo 20% na ọrịa kansa pancreatic [6,7].Ntinye aka na cervical na ọrịa cancer pancreatic na-adịkarị ụkọ, na-enwe naanị ikpe anọ a kọrọ na akwụkwọ, karịsịa ndị metụtara C2 [8-11].Ntinye aka nke spinal nwere ike ịbụ asymptomatic, ma mgbe ejikọtara ya na mgbaji, ọ nwere ike ibute mgbu na-enweghị nchịkwa na enweghị ntụkwasị obi nke siri ike ịchịkwa ya na usoro nchekwa ma nwee ike ibute onye ọrịa ahụ na mkpakọ ọkpụkpụ azụ.Ya mere, vertebroplasty bụ nhọrọ maka nkwụsi ike nke ọkpụkpụ azụ ma jikọta ya na mgbu mgbu na ihe karịrị 80% nke ndị ọrịa na-eme usoro a [12].
Ọ bụ ezie na usoro ahụ nwere ike ịrụ ọrụ nke ọma na ọkwa C2, usoro ahụ dị mgbagwoju anya na-emepụta ihe isi ike na nkà na ụzụ ma nwee ike ịkpata nsogbu.E nwere ọtụtụ akụkụ akwara ozi dị n'akụkụ C2, ebe ọ bụ n'ihu pharynx na larynx, n'akụkụ oghere carotid, posterolateral na akwara vertebral na akwara cervical, na azụ na sac [13].Ugbu a, a na-eji ụzọ anọ na PVP: anterolateral, posterolateral, transoral, and translational.A na-emekarị usoro nke anterolateral n'ọnọdụ dị elu ma na-achọ hyperextension nke isi iji bulie mandible ma kwado ohere C2.Ya mere, usoro a nwere ike ọ gaghị adabara ndị ọrịa na-enweghị ike ịnọgide na-enwe hyperextension isi.A na-agafe agịga ahụ site na parapharyngeal, retropharyngeal na prevertebral oghere na a na-eji aka na-eji nlezianya na-ejizi usoro posterolateral nke sheath carotid artery.Site na usoro a, mmebi nke akwara vertebral, akwara carotid, vein jugular, submandibular gland, oropharyngeal na IX, X na XI cranial akwara ga-ekwe omume [13].Cerebellar infarction na C2 neuralgia nke abụọ na ntapu ciment na-ewerekwa ihe mgbagwoju anya [14].Usoro nke posterolateral adịghị achọ ọgwụgwọ izugbe, enwere ike iji ya mee ihe na ndị ọrịa na-enweghị ike ịgbatị olu, a na-emekarị ya n'ọnọdụ dị elu.A na-agafe agịga ahụ site na oghere cervical dị n'azụ na ihu, cranial na medial direction, na-agbalị ka ọ ghara imetụ akwara vertebral na ikpu ya aka.Ya mere, nsogbu na-ejikọta ya na mmebi nke akwara vertebral na ọkpụkpụ azụ [15].Ịnweta transoral adịchaghị mgbagwoju anya na teknụzụ yana gụnyere iwebata agịga n'ime mgbidi pharyngeal na oghere pharyngeal.Na mgbakwunye na mmebi nwere ike imebi akwara vertebral, usoro a na-ejikọta ya na ihe ize ndụ dị elu nke ọrịa na nsogbu ndị dị ka pharyngeal abscesses na meningitis.Ụzọ a na-achọkwa nhụsianya n'ozuzu na intubation [13,15].Site na ịnweta mpụta, a na-etinye agịga ahụ n'ime oghere nwere ike dị n'etiti sheaths nke akwara carotid na vertebral artery n'akụkụ elu nke C1-C3, ebe ihe ize ndụ nke imebi arịa ndị bụ isi dị elu [13].Mgbagwoju anya nke ụzọ ọ bụla bụ mwepu nke ciment ọkpụkpụ, nke nwere ike ibute mkpakọ nke eriri azụ ma ọ bụ mgbọrọgwụ akwara [16].
Achọpụtala na iji agịga gbagọrọ agbagọ n'ọnọdụ a nwere uru ụfọdụ, gụnyere mmụba n'ozuzu ohere mgbanwe na ntụgharị agịga.Agịga a gbagọrọ agbagọ na-enye aka na: ikike ịhọrọ iche n'akụkụ dị iche iche nke vertebral ahụ, ntinye ntinye nke etiti nke a pụrụ ịdabere na ya, oge usoro oge, belata ọnụ ọgụgụ nke cementi, na belata oge fluoroscopy [4,5].Dabere na nyocha anyị nke akwụkwọ ndị ahụ, a naghị akọpụta iji agịga gbagọrọ agbagọ na spain cervical, na n'okwu ndị dị n'elu, a na-eji agịga kwụ ọtọ maka vertebroplasty posterolateral na ọkwa C2 [15,17-19].N'iburu n'ihe gbasara ahụ dị mgbagwoju anya nke mpaghara olu, mmụba n'ịgbagharị ụzọ agịga agbagọ nwere ike ịba uru karịsịa.Dị ka e gosipụtara n'ọnọdụ anyị, a na-arụ ọrụ ahụ n'akụkụ dị mma ma anyị gbanwere ọnọdụ nke agịga iji jupụta ọtụtụ akụkụ nke ọnya ahụ.Na akụkọ ikpe na-adịbeghị anya, Shah et al.Agịga gbagọrọ agbagọ hapụrụ ka ekpughere kyphoplasty balloon n'ezie, na-atụ aro ka enwere ike gbagwojuru anya nke agịga gbagọrọ agbagọ: ọdịdị nke agịga ahụ nwere ike ịkwado iwepụ ya [20].
N'okwu a, anyị na-egosipụta ọgwụgwọ na-aga nke ọma nke ọkpụkpụ ọkpụkpụ na-adịghị akwụ ụgwọ nke C2 vertebral body na-eji PVP posterolateral na agịga a gbagọrọ agbagọ na CT fluoroscopy nke na-adịghị akwụsị akwụsị, na-eme ka ọkpụkpụ gbajie na-emeziwanye nchịkwa mgbu.Usoro agịga gbagọrọ agbagọ bụ uru: ọ na-enye anyị ohere iru ọnya ahụ site na ụzọ nchekwa posterolateral dị mma ma na-enye anyị ohere ịmegharị agịga ahụ n'akụkụ niile nke ọnya ahụ na nke ọma ma mejupụta ọnya ahụ na ciment PMMA.Anyị na-atụ anya na usoro a nwere ike igbochi ojiji nke anesthesia chọrọ maka ohere transoropharyngeal ma zere nsogbu akwara ozi metụtara ụzọ ihu na ihu.
Ihe gbasara mmadụ: Ndị niile sonyere na ọmụmụ ihe a nyere ma ọ bụ enyeghị nkwenye.Esemokwu nke Mmasị: N'ikwekọ n'ụdị ngosi nke ICMJE Uniform, ndị edemede niile na-ekwupụta ihe ndị a: Ozi ịkwụ ụgwọ/ Ozi Ọrụ: Ndị ode akwụkwọ niile na-ekwupụta na ha enwetaghị nkwado ego n'aka ụlọ ọrụ ọ bụla maka ọrụ etinyere.Mmekọrịta ego: Ndị ode akwụkwọ niile na-ekwupụta na ha enweghị ugbu a ma ọ bụ n'ime afọ atọ gara aga nwere mmekọrịta ego na ụlọ ọrụ ọ bụla nwere ike ịmasị ọrụ etinyere.Mmekọrịta ndị ọzọ: Ndị ode akwụkwọ niile na-ekwupụta na enweghị mmekọrịta ma ọ bụ mmemme ndị ọzọ nwere ike imetụta ọrụ etinyere.
Swarnkar A, Zane S, Christie O, et al.(May 29, 2022) Vertebroplasty maka mgbaji C2 pathological: ikpe ụlọ ọgwụ pụrụ iche na-eji usoro agịga agbagọ.Ọgwụgwọ 14 (5): e25463.doi:10.7759/cureus.25463
© Copyright 2022 Svarnkar et al.Nke a bụ akụkọ ohere mepere emepe ekesara n'okpuru usoro ikike nke Creative Commons Attribution CC-BY 4.0.Eji, nkesa na mmeputakwa na-akparaghị ókè anabatara na usoro ọ bụla, ma ọ bụrụhaala na akwadoro onye edemede mbụ na isi mmalite.
Nke a bụ akụkọ ohere mepere emepe ekesara n'okpuru ikikere ikike ikike okike, nke na-enye ohere iji, nkesa, na mmeputakwa na-enweghị njedebe na usoro ọ bụla, ma ọ bụrụhaala na enwetara onye odee na isi mmalite.
Ogwe A na-egosi mmebi iwu dị iche na cortical (akụ) n'akụkụ aka nri nke C2 vertebral ahụ.Mgbasawanye asymmetric nke nkwonkwo atlantoaxial aka nri na cortical irregularity na C2 (akụ oke, B).Nke a, yana nghọta nke oke n'akụkụ aka nri nke C2, na-egosi mgbawa nke pathological.
Ihe onyonyo kọmputa (CT) na-egosi nkọwa nke usoro ahụ.A) Na mbido, etinyere ihe nlere anya 11 dị n'èzí site na ụzọ a na-eme atụmatụ nke ọma posterolateral.B) Ntinye nke agịga gbagọrọ agbagọ (akụ abụọ) site na cannula (otu akụ) n'ime ọnya ahụ.A na-etinye ọnụ ọnụ agịga ahụ ala na karịa n'etiti.C) Polymethyl methacrylate (PMMA) simenti na-agbanye n'ime ala nke ọnya ahụ.D) A na-eweghachi agịga a gbatọrọ agbagọ ma tinyeghachi ya n'akụkụ etiti dị elu, wee gbanye ciment PMMA.E) na F) na-egosi nkesa simenti PMMA mgbe a gwọchara ya na ụgbọ elu coronal na sagittal.
Ọkammụta Mmetụta Quotient ™ (SIQ™) bụ usoro nleba anya ndị ọgbọ anyị biputere pụrụ iche.Chọpụta ihe ndị ọzọ ebe a.
Njikọ a ga-akpọrọ gị gaa na webụsaịtị ndị ọzọ na-esoghị Cureus, Inc. Biko mara na Cureus abụghị maka ọdịnaya ma ọ bụ ihe omume ọ bụla dị na ibe anyị ma ọ bụ saịtị mmekọ.
Ọkammụta Mmetụta Quotient ™ (SIQ™) bụ usoro nleba anya ndị ọgbọ anyị biputere pụrụ iche.SIQ™ na-enyocha mkpa na ịdị mma nke akụkọ site na iji amamihe mkpokọta nke obodo Cureus dum.A na-akwado ndị ọrụ niile edebanyere aha ka ha tinye aka na SIQ™ nke akụkọ ọ bụla ebipụtara.(Ndị ode akwụkwọ enweghị ike ịkọ akụkọ nke ha.)
Ekwesịrị idobere ọkwa dị elu maka ọrụ ọhụrụ n'ezie na mpaghara ha.Uru ọ bụla dị n'elu 5 kwesịrị ka a tụlee karịa nkezi.Ọ bụ ezie na ndị ọrụ Cureus niile edebanyere aha nwere ike tụọ akụkọ ọ bụla ebipụtara, echiche ndị ọkachamara gbasara isiokwu na-ebu ibu karịa echiche nke ndị na-abụghị ọkachamara.SIQ™ nke akụkọ ga-apụta n'akụkụ akụkọ ahụ ka emechara ya ugboro abụọ, a ga-agbakọkwa ya na akara ọ bụla ọzọ.
Ọkammụta Mmetụta Quotient ™ (SIQ™) bụ usoro nleba anya ndị ọgbọ anyị biputere pụrụ iche.SIQ™ na-enyocha mkpa na ịdị mma nke akụkọ site na iji amamihe mkpokọta nke obodo Cureus dum.A na-akwado ndị ọrụ niile edebanyere aha ka ha tinye aka na SIQ™ nke akụkọ ọ bụla ebipụtara.(Ndị ode akwụkwọ enweghị ike ịkọ akụkọ nke ha.)
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