Temperature Control of Bone Cement for Enhancing Applicability and Safety in Vertebroplasty

2014 ◽  
Vol 684 ◽  
pp. 395-399
Author(s):  
Ching Lung Tai ◽  
Yi Lu Chen ◽  
Shen Yao Chen
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Temperature Control ◽  
Vertebral Fractures ◽  
Reaction Rate ◽  
Environmental Temperature ◽  
Handling Time ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Fractures ◽  
Cement Distribution

Vertebroplasty has been widely accepted in treatment of osteoporotic vertebral fractures. Polymerization of bone cement stabilizes the fractured vertebra by increasing its mechanical strength, thereby providing symptomatic pain relief. Many factors affect the reaction of polymerization of polymethylmethacrylate and, therefore, the reaction rate and injection permeability of bone cement. This may increase the probability of a surgeon missing the crucial period, leading to the increase of the risks of uneven cement distribution, cement leakage and premature hardening of cement. Hypothermic manipulation of bone cement is expected to reduce reaction rate and hence, extending the handling time. However, in a manner of reducing the environmental temperature of bone cement, there are still uncertainties on handling time, cement distribution pattern and injection permeability of cement. This study is thus designed to investigate the efficacy of temperature control for enhancing applicability and safety of bone cement.

scholarly journals Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

2019 ◽  
Vol 47 (9) ◽  
pp. 4505-4513 ◽  
Author(s):  
Kai Xu ◽  
Ya-Ling Li ◽  
Fei Song ◽  
Hua-Wei Liu ◽  
Hua-Dong Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Fracture Line ◽  
Vertebral Augmentation ◽  
Bilateral Group ◽  
Significant Difference ◽  
Cement Distribution ◽  
Unilateral Group

Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

scholarly journals Percutaneous Kyphoplasty Evaluated by Cement Volume and Distribution: An Analysis of Clinical Data

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. 495-506
Author(s):  
Dingjun Hao
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Vertebral Fractures ◽  
Epidemiological Data ◽  
Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Percutaneous Kyphoplasty ◽  
Cement Distribution ◽  
Surgery Outcomes

Background: Percutaneous kyphoplasty (PKP) could achieve rapid pain relief for older patients with osteoporotic vertebral compression fractures (OVCFs). Bone cement in PKP was the key factor keeping the stabilization of the vertebral body. However, the same amount of cement can distribute differently in a vertebral body and can thereby result in different surgery outcomes. Therefore, the volume and distribution of bone cement should be considered as 2 distinct variables to evaluate the effectiveness of PKP. Objectives: On the basis of comparing surgery outcomes between patients with different recovery states measured by visual analog scores (VAS) and exploring the relationships among bone cement, surgery outcomes, and degrees of pain relief, the objective of the study is to determine the best combination of cement volume and cement distribution for PKP. Study Design: Retrospective study. Methods: There were 220 patients with 220 vertebra who received PKP in our hospital from January 2011 to January 2013. According to the different pain relief degrees, patients were divided into 2 groups. The epidemiological data, surgical outcomes, and complications were compared between the 2 groups. A receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of bone cement on patient recovery state. A correlation analysis was used to analyze the relationships between bone cement and surgery outcomes. Moreover, logistic regression was also used to assess the safety of cement injection. Results: There were 77 recuperators and 143 non-recuperators in our study. There were no differences in epidemiological data between the 2 groups. However, the surgery duration, cement volume, cement distribution, restoration rate of vertebral height, and improvement of kyphotic angle in the recuperator group were all higher than those in the non-recuperator group. The area under the ROC curve of cement distribution as a predictor of pain relief was better than that of cement volume (0.77 vs. 0.65, P < 0.05). Cement distribution had a sensitivity of 62% and a specificity of 84% when it was at 0.49. Cement volume had a sensitivity of 49% and a specificity of 82% when it was at 3.80 mL. All patients were then divided into 4 parts based on the 2 values. Extensive cement distribution (more than or equal to 0.49) was discovered to noticeably increase the recuperative rate both for a small cement volume (less than 3.80 mL) and a large cement volume (more than or equal to 3.80 mL). A small cement volume with an extensive distribution had the same recuperative effect as a large cement volume with a confined distribution (χ2 = 2.880, P = 0.090). When the cement volume was constant, cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r2 = 0.207, P < 0.01; r2 = 0.159, P = 0.02), but cement distribution was not a risk factor for cement leakage or adjacent vertebral fractures (OR = 35.760, 95%CI: 0.096 – 13291.207, P > 0.05; OR = 0.051, 95% CI: 0.011 – 1.032, P > 0.05). Although a large cement volume may contribute to the restoration of vertebral height (r2 = 0.153, P < 0.05), it was found to be a risk factor for adjacent vertebral fractures (OR = 1.733, 95% CI: 1.158 – 2.595, P < 0.05). Limitations: The distribution of cement in fractured vertebra was not calcuated accurately. Conclusions: The diagnostic value of cement distribution is better than that for cement volume in relieving patient pain. A cement distribution above 0.49 with a small cement volume should be suggested for PKP. An extensive cement distribution can improve the kyphotic angle and vertebral height effectively, and it does not cause cement leakage or adjacent vertebral fractures. Key words: Psteoporotic vertebral compression fractures percutaneous kyphoplasty cement volume cement distribution

scholarly journals Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

2020 ◽  
Author(s):  
Jun Yan ◽  
Qiaohui Liu ◽  
Yanping Zheng ◽  
Ziqun Liu ◽  
Xinyu Liu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Pulsed Jet ◽  
Jet Lavage ◽  
Average Maximum ◽  
Cement Distribution ◽  
Vertebral Bodies

Abstract Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

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 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.

Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures

2002 ◽  
Vol 97 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Masato Nakano ◽  
Norikazu Hirano ◽  
Kousou Matsuura ◽  
Hiroki Watanabe ◽  
Hideki Kitagawa ◽  
...  
Keyword(s):  
Back Pain ◽  
Calcium Phosphate ◽  
Pain Relief ◽  
Vertebral Fractures ◽  
Calcium Phosphate Cement ◽  
Content Type ◽  
Osteoporotic Vertebral Fractures ◽  
The Mean ◽  
Fine Print

Object. Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). Methods. Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. Conclusions. Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.

scholarly journals Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Wenwu Zhang ◽  
Shenpeng Liu ◽  
Xianhua Liu ◽  
Xiang Li ◽  
Le Wang ◽  
...  
Keyword(s):  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Operation Time ◽  
Transverse Process ◽  
Cement Leakage ◽  
Clinical Results ◽  
Clinical Effects ◽  
Compression Fractures ◽  
Transpedicular Approach ◽  
Cement Distribution

Abstract Purpose Percutaneous vertebroplasty (PVP) is a routine operation for the treatment of osteoporotic lumbar compression fractures (OLCFs). As is well known, unilateral puncture is a common method. However, with the conventional transpedicular approach (CTPA), the cement may be asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study was to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA to identify the advantages and disadvantages of the two surgical options. Patients and methods From January 2016 to June 2019, seventy-two elderly patients who underwent unilateral PVP for single-level OLCF were retrospectively reviewed. Operation time, injection amount and type of bone cement distribution, and bone cement leakage and surgical complications were recorded. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for more than 12 months, and the assessment was based primarily on clinical and radiological outcomes. Results There were significant differences in the surgical time and the volume and the type of bone cement distribution and the lost of operative vertebra height between the two groups. However, there was no significant difference in bone cement leakage. Moreover, there were no significant differences in VAS and ODI between the two groups at 2 days and 12 months after the operation. Conclusions Unilateral TPRPA and CTPA are practical and feasible methods in PVP for the treatment of OLCF, and they have similar clinical effects. However, TPRPA has the advantages of a better distribution of bone cement and a shorter operation time and a better maintenance effect of injured vertebra height, without increasing the rate of bone cement leakage.

scholarly journals Clinical Efficacy of Different Bone Cement Distribution Patterns in Percutaneous Kyphoplasty: A Retrospective Study

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. E409-E416
Author(s):  
Tianming Zou
Keyword(s):  
Bone Cement ◽  
Clinical Outcomes ◽  
Distribution Patterns ◽  
Cement Leakage ◽  
Percutaneous Kyphoplasty ◽  
Significant Difference ◽  
Cement Distribution ◽  
Group A ◽  
The Mean

Background: Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). Objectives: The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. Study Design: A retrospective cohort study. Setting: An affiliated people’s hospital of a university. Methods: According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. Results: A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56–94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30–140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2–15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. Limitations: Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. Conclusions: Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. Key words: Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns

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