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Does Balloon Kyphoplasty Deliver More Cement Safely into Osteoporotic Vertebrae with Compression Fractures Compared with Vertebroplasty? A Study in Vertebral Analogues.

Abduljabbar FH, Al-Jurayyan A, Alqahtani S, Sardar ZM, Saluja RS, Ouellet J, Weber M, Steffen T, Beckman L, Jarzem P - Global Spine J (2015)

Bottom Line: The main outcome measured was the volume of the cement injected safely into a vertebra before leakage through the posterior vascular channel.One-way analysis of variance comparing the four groups showed a statistically significant difference (p < 0.005).Conclusions High-viscosity cement injected using vertebroplasty delivers more cement volume before cement leakage and fills the vertebral body more uniformly when compared with balloon kyphoplasty in osteoporotic vertebrae with compression fractures.

View Article: PubMed Central - PubMed

Affiliation: McGill Scoliosis and Spine Centre, McGill University Health Centre, Montreal, Canada ; Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.

ABSTRACT
Study Design A biomechanical and radiographic study using vertebral analogues. Objectives Kyphoplasty and vertebroplasty are widely used techniques to alleviate pain in fractures secondary to osteoporosis. However, cement leakage toward vital structures like the spinal cord can be a major source of morbidity and even mortality. We define safe cement injection as the volume of the cement injected into a vertebra before the cement leakage occurs. Our objective is to compare the amount of cement that can be safely injected into an osteoporotic vertebra with simulated compression fracture using either vertebroplasty or balloon kyphoplasty techniques. Methods Forty artificial vertebral analogues made of polyurethane with osteoporotic cancellous matrix representing the L3 vertebrae were used for this study and were divided into four groups of 10 vertebrae each. The four groups tested were: low-viscosity cement injected using vertebroplasty, high-viscosity cement injected using vertebroplasty, low-viscosity cement injected using balloon kyphoplasty, and high-viscosity cement injected using balloon kyphoplasty. The procedures were performed under fluoroscopic guidance. The injection was stopped when the cement started protruding from the created vascular channel in the osteoporotic vertebral fracture model. The main outcome measured was the volume of the cement injected safely into a vertebra before leakage through the posterior vascular channel. Results The highest volume of the cement injected was in the vertebroplasty group using high-viscosity cement, which was almost twice the injected volume in the other three groups. One-way analysis of variance comparing the four groups showed a statistically significant difference (p < 0.005). Conclusions High-viscosity cement injected using vertebroplasty delivers more cement volume before cement leakage and fills the vertebral body more uniformly when compared with balloon kyphoplasty in osteoporotic vertebrae with compression fractures.

No MeSH data available.


Related in: MedlinePlus

Sagittal (a) and coronal (b) images showing the filling pattern of the high-viscosity vertebroplasty technique with cement filling most of the vertebral body uniformly. Sagittal (c) and coronal (d) images for the high-viscosity kyphoplasty technique, which demonstrates less vertebral filling with cement.
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FI1400115-6: Sagittal (a) and coronal (b) images showing the filling pattern of the high-viscosity vertebroplasty technique with cement filling most of the vertebral body uniformly. Sagittal (c) and coronal (d) images for the high-viscosity kyphoplasty technique, which demonstrates less vertebral filling with cement.

Mentions: The high-viscosity vertebroplasty group showed the most filling of vertebral body (Fig. 5d). In this group, the cement diffusely and densely packed the entire vertebral body radiating out from the trocar tip until it leaked from the posterior wall of vertebral body. The high-viscosity balloon kyphoplasty group showed patterns similar to the low-viscosity balloon kyphoplasty group (Fig. 5e). The cement filled the cavity created by the balloon in the anterior-to-posterior direction until it protruded from the posterior vascular channel, with little spread of the cement outside of the cavity created by the balloon. Fig. 6 further illustrates these differences in the filling pattern by showing fluoroscopic images in the coronal and sagittal vertebral planes filled by either the vertebroplasty or kyphoplasty technique using high-viscosity cement. Note the greater cement fill for the high-viscosity vertebroplasty technique.


Does Balloon Kyphoplasty Deliver More Cement Safely into Osteoporotic Vertebrae with Compression Fractures Compared with Vertebroplasty? A Study in Vertebral Analogues.

Abduljabbar FH, Al-Jurayyan A, Alqahtani S, Sardar ZM, Saluja RS, Ouellet J, Weber M, Steffen T, Beckman L, Jarzem P - Global Spine J (2015)

Sagittal (a) and coronal (b) images showing the filling pattern of the high-viscosity vertebroplasty technique with cement filling most of the vertebral body uniformly. Sagittal (c) and coronal (d) images for the high-viscosity kyphoplasty technique, which demonstrates less vertebral filling with cement.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4516756&req=5

FI1400115-6: Sagittal (a) and coronal (b) images showing the filling pattern of the high-viscosity vertebroplasty technique with cement filling most of the vertebral body uniformly. Sagittal (c) and coronal (d) images for the high-viscosity kyphoplasty technique, which demonstrates less vertebral filling with cement.
Mentions: The high-viscosity vertebroplasty group showed the most filling of vertebral body (Fig. 5d). In this group, the cement diffusely and densely packed the entire vertebral body radiating out from the trocar tip until it leaked from the posterior wall of vertebral body. The high-viscosity balloon kyphoplasty group showed patterns similar to the low-viscosity balloon kyphoplasty group (Fig. 5e). The cement filled the cavity created by the balloon in the anterior-to-posterior direction until it protruded from the posterior vascular channel, with little spread of the cement outside of the cavity created by the balloon. Fig. 6 further illustrates these differences in the filling pattern by showing fluoroscopic images in the coronal and sagittal vertebral planes filled by either the vertebroplasty or kyphoplasty technique using high-viscosity cement. Note the greater cement fill for the high-viscosity vertebroplasty technique.

Bottom Line: The main outcome measured was the volume of the cement injected safely into a vertebra before leakage through the posterior vascular channel.One-way analysis of variance comparing the four groups showed a statistically significant difference (p < 0.005).Conclusions High-viscosity cement injected using vertebroplasty delivers more cement volume before cement leakage and fills the vertebral body more uniformly when compared with balloon kyphoplasty in osteoporotic vertebrae with compression fractures.

View Article: PubMed Central - PubMed

Affiliation: McGill Scoliosis and Spine Centre, McGill University Health Centre, Montreal, Canada ; Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.

ABSTRACT
Study Design A biomechanical and radiographic study using vertebral analogues. Objectives Kyphoplasty and vertebroplasty are widely used techniques to alleviate pain in fractures secondary to osteoporosis. However, cement leakage toward vital structures like the spinal cord can be a major source of morbidity and even mortality. We define safe cement injection as the volume of the cement injected into a vertebra before the cement leakage occurs. Our objective is to compare the amount of cement that can be safely injected into an osteoporotic vertebra with simulated compression fracture using either vertebroplasty or balloon kyphoplasty techniques. Methods Forty artificial vertebral analogues made of polyurethane with osteoporotic cancellous matrix representing the L3 vertebrae were used for this study and were divided into four groups of 10 vertebrae each. The four groups tested were: low-viscosity cement injected using vertebroplasty, high-viscosity cement injected using vertebroplasty, low-viscosity cement injected using balloon kyphoplasty, and high-viscosity cement injected using balloon kyphoplasty. The procedures were performed under fluoroscopic guidance. The injection was stopped when the cement started protruding from the created vascular channel in the osteoporotic vertebral fracture model. The main outcome measured was the volume of the cement injected safely into a vertebra before leakage through the posterior vascular channel. Results The highest volume of the cement injected was in the vertebroplasty group using high-viscosity cement, which was almost twice the injected volume in the other three groups. One-way analysis of variance comparing the four groups showed a statistically significant difference (p < 0.005). Conclusions High-viscosity cement injected using vertebroplasty delivers more cement volume before cement leakage and fills the vertebral body more uniformly when compared with balloon kyphoplasty in osteoporotic vertebrae with compression fractures.

No MeSH data available.


Related in: MedlinePlus