scholarly journals A Medium Viscous Acrylic Cement Enhances Uniformity of Cement Filling and Reduces Leakage in Cancellous Bone Augmentation

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Andreas Boger ◽  
Kurtis Wheeler
Keyword(s):  
Force Feedback ◽  
Cement Leakage ◽  
Bone Augmentation ◽  
Clinical Value ◽  
Efficient Procedure ◽  
Medical Products ◽  
Acrylic Cement ◽  
Low Viscosity ◽  
Osteoporotic Vertebral Fractures ◽  
Injection Forces

Vertebroplasty is an efficient procedure to treat osteoporotic vertebral fractures. Cement leakage is considered to be the most severe complication during vertebroplasty. At high cement viscosities, the risk of leakage is reduced. However, injection forces are highly increased, requiring the use of high force injection systems with the lack in tactile force feedback. Therefore, an acrylic cement was developed showing medium initial viscosity and which still allows to be manually applied using syringes. An established model favoring leakage was used to observe the filling pattern and leaked cement mass. The method used included the simulation of body temperature, and all materials submitted are approved medical products. When applied just after preparation, the medium viscous cement resulted in good cement filling and less cement leakage than low viscosity cement. The added clinical value of the new cement is that the waiting time for the physician will be shortened to zero minutes without compromising the safety for the procedure.

scholarly journals Effects of Polymethylmethacrylate Cement Viscosity and Bone Porosity on Cement Leakage and New Vertebral Fractures After Percutaneous Vertebroplasty: A Prospective Study

2019 ◽  
Vol 9 (7) ◽  
pp. 754-760 ◽  
Author(s):  
Mohamed Alhashash ◽  
Mootaz Shousha ◽  
Ahmed Samir Barakat ◽  
Heinrich Boehm
Keyword(s):  
Vertebral Fractures ◽  
Statistical Significance ◽  
Significant Risk ◽  
Cement Leakage ◽  
Low Viscosity ◽  
Osteoporotic Vertebral Fractures ◽  
Group A ◽  
Vertebral Bodies ◽  
The Difference ◽  
Group B

Study Design: A prospective randomized study. Objectives: To evaluate the effect of bone cement viscosity as well as of bone porosity on cement leakage during vertebroplasty and to analyze the occurrence of new vertebral fractures after the procedure. Methods: Between April 2012 and December 2013, 60 patients suffering from osteoporotic vertebral fractures underwent vertebroplasty. The patients were randomly assigned into 2 equal groups. High-viscosity cement was used in group A, while low-viscosity cement was used in group B. Patients were followed-up for a minimum of 2 years. Results: Cement leakage occurred in 16 patients in group B (20 vertebral bodies) and in 6 patients in group A (9 vertebral bodies). The difference was statistically significant (χ2 = 2.3, P = .01). Lower T-scores were associated with significantly more cement leakage ( t = 3.338, P = .002 in group A, and t = 4.329, P = .000 in group B). Patients with a T-score worse than −1.8 had a significantly higher risk of cement leakage if low-viscosity cement was used (χ2 = 3.25, P = .05). New vertebral fractures occurred in 14 (23%) patients, after a mean of 6.5 ± 5.5 months, 10 patients in group A and 4 in group B. The difference did not reach the statistical significance level (χ2 = 3.354, P = .067). Patients presenting with multiple fractures had a significantly more number of new vertebral fractures (χ2 = 7.464, P = .006). Conclusions: The clinical outcome of vertebroplasty was not influenced by cement viscosity. However, lower cement viscosity and higher degree of osteoporosis were found to be significant risk factors for cement leakage. Furthermore, the number of vertebral body fractures on presentation was a predictor for the occurrence of new fractures postoperatively.

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

2020 ◽  
Author(s):  
Feng Miao ◽  
Xiaojun Zeng ◽  
Wei Wang ◽  
Zhou Zhao
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Body Height ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Low Viscosity ◽  
Pain Scores ◽  
Group A ◽  
Group B

Abstract Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

Microsurgical interlaminary vertebro- and kyphoplasty for severe osteoporotic fractures

2004 ◽  
Vol 100 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Bronek M. Boszczyk ◽  
Michael Bierschneider ◽  
Katharina Schmid ◽  
Andreas Grillhösl ◽  
Björn Robert ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Osteoporotic Fractures ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Decompressive Surgery ◽  
Content Type ◽  
Osteoporotic Vertebral Fractures ◽  
Four Levels ◽  
Fine Print

Object. Percutaneous vertebro- and kyphoplasty have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures. In the setting of severe fractures involving fragmentation of the posterior wall and neural compromise, however, decompressive surgery cannot be performed and epidural cement leakage is poorly controlled. A microsurgical interlaminary approach for vertebro- and kyphoplasty was developed to allow spinal decompression and control of the spinal canal during augmentation. Methods. Interlaminary vertebro- or kyphoplasty was performed in 24 patients with osteoporotic fractures involving neural compression or posterior wall fragmentation. After unilateral microsurgical fenestration, decompression of the spine, and gentle mobilization of the thecal sac, vertebro- or kyphoplasty was performed directly through the posterior wall of the fractured vertebral body. Cement was injected under microscopic and fluoroscopic control, with the option of immediate exploration of the exposed spinal canal. Thirty-four levels (T-8 to L-5) were treated. Mean blood loss was less than 100 ml and augmentation added 10 to 40 minutes to the entire procedure. Cement leakage associated with the kyphoplasty procedure was less than that in vertebroplasty. There were no major complications. One patient was lost to follow up. Clinical outcome was good or excellent in 17 of the 23 patients available for follow-up (1 to 31—month) evaluation. Conclusions. The present microsurgical interlaminary approach for vertebro- and kyphoplasty enables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decompressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively. This technique can be regarded as a procedure on the treatment continuum between percutaneous augmentation and conventional open reconstruction.

scholarly journals Parathyroid Hormone Injection Versus Vertebroplasty in the Treatment of Osteoporotic Vertebral Fracture in Old Age: A Retrospective Study of 58 Female Patients

2020 ◽  
Author(s):  
Incheol Kook ◽  
Byeong-Jik Kang ◽  
Ye-Soo Park
Keyword(s):  
Parathyroid Hormone ◽  
Retrospective Study ◽  
Vertebral Fracture ◽  
Conservative Treatment ◽  
Vertebral Fractures ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Fracture ◽  
Group I ◽  
Osteoporotic Vertebral Fractures

Abstract Background: While the indications of parathyroid hormone (PTH) in osteoporosis prevention and management have been established, its indications in the treatment of osteoporotic vertebral fractures remain unknown. This study aimed to compare the effects of intervention (percutaneous vertebroplasty followed by anti-resorptive agents) and conservative treatment (PTH administration) in patients with osteoporotic vertebral fractures, as well as to investigate the optimal duration of PTH administration. Methods: A retrospective study was conducted using data of patients treated for osteoporotic vertebral fractures between January 2015 and November 2019. Treatment was selected based on the patient’s age, comorbidities, and patient’s preference after explaining the expected advantages and disadvantages of each treatment. Group C was administered PTH injections once weekly, whereas Group I underwent vertebroplasty followed by the administration of anti-resorptive agents. Radiological and clinical parameters were analyzed between two groups.Results: This study enrolled 58 patients (77 vertebrae). Group C included 24 patients (38 vertebrae) with average age of 77.50 ± 7.19 years (range, 65–85 years), average bone mineral density (BMD) of −3.39 ± 0.86 (range, −2.5 to −5.8), average follow-up period of 27.47 ± 7.60 weeks (range, 12–49 weeks). Group I included 34 patients (39 vertebrae) with an average age of 76.20 ± 8.67 years (range, 65–92 years), average BMD of −3.35 ± 0.91 (range, −2.5 to −5.1), average follow-up period of 30.82 ± 10.95 weeks (range, 16–59 weeks). There was no significant difference between the two groups in initial demographic, clinical and radiographic parameters. Group I showed significantly better clinical and radiological outcome during the last follow-up. Regarding side effects in Group C, two cases of dizziness (8.3%), nausea and vomiting (8.3%) were reported. In Group I, cement leakage was found in 26 vertebrae (66.7%), and cement leakage complications were observed in four patients (11.8%). Conclusion: Conservative treatment using PTH injection demonstrated slower pain relief and lesser suppression of vertebral height loss than vertebroplasty. However, PTH injection demonstrated a lower risk of procedure-related complications. The patient’s age, preference, and general condition with respect to the procedure’s risk should be considered when determining treatment options for osteoporotic vertebral fracture in old age.

scholarly journals Feasibility, Safety and Cement Leakage in Vertebroplasty of Osteoporotic and Malignant Compression Fractures Using Ultra-Viscous Cement and Hydraulic Delivery System

2012 ◽  
Vol 3;15 (3;5) ◽  
pp. 223-228
Author(s):  
Bassem A Georgy
Keyword(s):  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Retrospective Evaluation ◽  
Single Center ◽  
Compression Fractures ◽  
Low Viscosity ◽  
Institutional Review ◽  
Malignant Lesions ◽  
Level 2 ◽  
Venous Leakage

Background: The major complications arising from vertebroplasty or kyphoplasty are related to leakage of cement beyond the confines of the collapsed vertebral body. Traditionally, a liquid (low viscosity) cement is used in most vertebroplasty systems available on the market, coupled with mechanical injection devices or one mL syringes. Objectives: The purpose of this study is to evaluate the feasibility and safety, as well as study cement leakage patterns, in vertebroplasty performed for both osteoporotic and malignant vertebral compression fractures using ultraviscous cement injected by the hydraulic CONFIDENCE Vertebral Augmentation System. Study Design: Retrospective evaluation of postoperative images. Setting: Single center inpatient and outpatient population. Methods: A retrospective evaluation of clinical charts and postoperative X-ray imaging was performed in 122 cases; a total of 214 levels were treated. The study group comprised a total of 163 levels of benign osteoporotic fractures and 51 levels of various malignant lesions. The degree of leakage, seen in postoperative films, was assessed at each treated level using a strict 4-point scale (none, mild, moderate, severe). Results: For benign lesions, there was no leakage in 82 levels (50%), mild venous leakage in 38 levels (23%), moderate venous leakage in 4 levels (2%), mild disc leakage in 28 levels (17%), moderate disc leakage in 7 levels (4%), mild paravertebral leakage in 2 levels (1%), and moderate paravertebral leakage in 2 levels (1%). No severe leakage or epidural leakage were seen. For malignant lesions, there was no leakage in 25 levels (49%), mild venous leakage in 12 levels (24%), moderate venous leakage in 4 levels (8%), mild disc leakage in 7 levels (14%), moderate disc leakage in one level (2%), mild paravertebral leakage in one level (2%), and one level showed a mild epidural leakage (2%). Limitations: Retrospective study, single center. Conclusion: Percutaneous cement augmentation in osteoporotic and malignant compression fractures using a highly viscous cement that can be safely controlled and injected via a hydraulic system can be performed safely without significant complications. The leakage rate and patterns were similar in both benign and malignant compression fractures. The use of highly viscous cement may decrease the complication rate in malignant lesions that has been traditionally described to exhibit more cement leakage with low viscosity cement. Institutional Review: This study was approved by the Institutional Review Board Key words: Vertebroplasty, high viscosity cement, CONFIDENCE system, hydraulic injection.

scholarly journals Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture

2009 ◽  
Vol 67 (2b) ◽  
pp. 377-381 ◽  
Author(s):  
Nicandro Figueiredo ◽  
Filipe Barra ◽  
Laryssa Moraes ◽  
Roger Rotta ◽  
Luiz Augusto Casulari
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Pain Control ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Fracture ◽  
Cement Injection ◽  
Osteoporotic Vertebral Fractures ◽  
Good Improvement

A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27% with the SOC, and 68% with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost.

scholarly journals Pulmonary Embolism with Vertebral Augmentation Procedures

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Swetha Bopparaju ◽  
Joseph Varon ◽  
Salim Surani
Keyword(s):  
Pulmonary Embolism ◽  
Management Strategies ◽  
Lumbar Vertebra ◽  
Cement Leakage ◽  
Vertebral Augmentation ◽  
Effective Management ◽  
Pulmonary Vessels ◽  
Ct Angiogram ◽  
Osteoporotic Vertebral Fractures ◽  
Pmma Cement

With the prevalence of an aging American population on the rise, osteoporotic vertebral fractures are becoming a common occurrence, resulting in an increase in vertebral augmentation procedures and associated complications such as cement leakage, vertebral compressions, and pulmonary embolism. We describe a patient who presented with respiratory distress three years following kyphoplasty of the lumbar vertebra. Computed tomography (CT) angiogram of the chest confirmed the presence of polymethylmethacrylate (PMMA) cement in the lung fields and pulmonary vessels. We conducted a systematic review of the published literature identifying effective management strategies for the treatment of vertebroplasty-associated pulmonary embolism.

scholarly journals Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Jin Luo ◽  
Michael A. Adams ◽  
Patricia Dolan
Keyword(s):  
Vertebral Body ◽  
Normal Values ◽  
Body Height ◽  
Cement Leakage ◽  
Future Research ◽  
Vertebral Body Height ◽  
Beneficial Effects ◽  
Osteoporotic Vertebral Fractures ◽  
Spine Mechanics ◽  
Normal Spine

Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture.

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