Cement Filling Control and Bone Marrow Removal in Vertebral Body Augmentation by Unipedicular Aspiration Technique

Abstract

The aspiration technique combined with a new cannula design improved the uniformity of filling. The aspiration technique helps in removal of the displaced bone marrow or tumor tissue. The aspiration applied with the new cannula requires only a single incision. Thus, it does not result in an increased invasiveness.

Novel methodology for assessing biomaterial–biofluid interaction in cancellous bone

“…The boundary of the surrogates simulated the vertebral shell which confines the flow and controls the intravertebral pressure, significantly affecting the filling pattern [28]. This is consistent with previous studies in which Loeffel et al [13] sealed their surrogates with a reusable acrylic enclosure, while Baroud et al [11] and Mohamed et al [14] coated their surrogates with a 1 mm layer of acrylic cement to mimic the vertebral shell. The boundary including the inlet and the flow exit points were kept constant for all the surrogates within this study.…”

“…Also, the surface wettability of the surrogates matches that of bone and the presence of the marrow substitute simulates the two-phase flow that occurs within the vertebral body. In previous studies, Bohner et al [8] and Loeffel et al [13] both used melted cow butter, whereas Baroud et al [11] and Mohamed et al [14] both used a water/gelatin solution. A true representation of the rheological properties of human red bone marrow present within the cancellous bone is extremely important as such properties significantly affect the cement flow behaviour [8].…”

“…Previous experimental studies on cement flow [8,[11][12][13][14] have used open-porous aluminum foam to represent osteoporotic bone. Although the porosity was well controlled, the geometrical structure of each of the foams was inherently unique.…”

Lavage prior to vertebral augmentation reduces the risk for cement leakage

“…It could be shown that (jet)-lavage does not cause cardiovascular reaction in combination with contralateral application of vacuum and can significantly decrease the embolic load in sheep [30]. Similar results, significant reductions of cement leakage, were found by Mohamed et al [33], using an unipedicular aspiration technique (without lavage) in a vertebroplasty model.…”

Assessing cement injection behaviour in cancellous bone: An in vitro study using flow models

“…[14][15][16][17][18] However, this is just one part of a wider requirement to understand how the cement flows within cancellous bone and accurately predict the cement placement within the vertebral body, which has been identified as a critical parameter in the biomechanical behaviour of the construct post-augmentation. 19,20 The rheological properties play a crucial role in the cement flow behaviour during injection and within a porous structure such as cancellous bone.…”