Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures.
The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 +/- 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.
Anselmetti
Giovanni Carlo
GC
Interventional Radiology Unit, Institute for Cancer Research and Treatment (IRCC), Strada Provinciale no. 142 km 3,95, Candiolo, Turin, 10060, Italy. giovanni.anselmetti@ircc.it
Zoarski
Gregg
G
Manca
Antonio
A
Masala
Salvatore
S
Eminefendic
Haris
H
Russo
Filippo
F
Regge
Daniele
D
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000494:pharmacology; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D010147:Pain Measurement; D019904:Polymethyl Methacrylate / Q000009:adverse effects / Q000494:pharmacology; D011336:Probability; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements; D019904:Polymethyl Methacrylate