Vertebral Body Lavage Reduces Hemodynamic Response to Vertebral Body Augmentation With PMMA

Albers, Christoph E.; Schott, Philipp M.; Ahmad, Sufian S.; Benneker, Lorin Michael; Nieuwkamp, Nadine; Hoppe, Sven

doi:10.1177/2192568218803106

“…It is believed that the diffusion of bone cement could be improved by reducing blood accumulation in fractured vertebrae without increasing the amount of bone cement and that the bone cement leakage caused by excessive amounts of bone cement could be avoided. Albers et al 25 reported that the vertebral body lavage reduces hemodynamic response to vertebral body augmentation with PMMA, most likely resulting from decreased amounts of bone marrow substance displaced into the circulation thereby decreasing the risk of pulmonary fat embolism syndrome. However, our team tried the technique of vertebral body lavage but we are still improving related tools to achieve a higher success rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Peng¹,

Qin²,

Huang³

et al. 2021

JPR

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Background A retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs). Methods From January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41). Results Visual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C. Conclusion Compared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.

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“…Some studies have shown that intravertebral lavage prior to cement injection can effectively remove the vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7]. Previously reported lavage methods involved bilateral operation [8][9][10], but the unilateral pulsed jet lavage method has not been described. Thus, we designed and used a unilateral pulsed jet lavage system to investigate the effect of unilateral irrigation prior to vertebroplasty on leakage, intravertebral pressure, and cement distribution.…”

Section: Introductionmentioning

confidence: 99%

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

Jiang

¹

,

Liu

²

,

Zheng

³

et al. 2020

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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.

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“…Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference…”

Section: Introductionmentioning

confidence: 99%

“…However, leakage during PVP or PKP remains a concern among surgeons. Some studies have shown that intravertebral lavage prior to cement injection can effectively remove vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7] .Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference…”

mentioning

confidence: 99%

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

Yan

¹

,

Liu

²

,

Zheng

³

et al. 2020

Preprint

0

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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. BackgroundPercutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) is effective in the treatment of osteoporotic vertebral compression fractures. These techniques can provide instant pain relief [1][2][3] and stabilize vertebral fracture [3][4][5] . However, leakage during PVP or PKP remains a concern among surgeons. Some studies have shown that intravertebral lavage prior to cement injection can effectively remove vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7] .Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference Leakage rateCement leakage was evaluated on the basis of the CT images. Cement leakage occurred in one (6.7%) of the irrigated specimens and in seven (46.7%) of the unirrigated ones (Table 1). Cement distributionCT images showed the distinct distributions of cement in the two groups. The bone cement mass was homogeneous and had more uniform density in the irrigated group than in the unirrigated group. The cement distribution of the unirrigated vertebrae was more irregular than that of the irrigated group (Fig.2). CMVThe Mann-Whitney U test results revealed smaller CMV in the irrigated group than in the unirrigated JY performed the experiments and participated in the design of the study. QL performed the experiments and wrote the manuscript. ZL, ...

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Vertebral Body Lavage Reduces Hemodynamic Response to Vertebral Body Augmentation With PMMA

Cited by 8 publications

References 18 publications

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

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

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

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