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

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 (4.92 kPa versus 2.22 kPa, 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.

Correlation analysis of the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein in vertebroplasty

“…Because the venous wall in the vertebral body is thin, when the intramedullary pressure exceeds the bearing range when bone cement is injected, bone cement particles are squeezed into the vein and cause paravertebral vein leakage. Yan J et al [ 26 ] reported it can reduce the cement leakage rate by decreasing the intravertebral pressure. Patients with higher bone density have greater resistance during vertebroplasty, and higher pressure is often required to inject the bone cement.…”

Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution—An Ex Vivo Study in Goat Vertebrae

“…Second, pulsed jet lavage was performed by vacuum aspiration to remove the vertebral fat and bone marrow. This process before cement injection is effective to reduce CL, fat embolism, and enhance filling distribution [41][42][43]. Furthermore, suction can be used for tumor debulking through bilateral punctures.…”