Vertebroplasty using real-time, fluoroscopy-controlled, catheter-assisted, low-viscosity cement injection.
METHODS
Case series.


OBJECTIVE
Evaluation of new vertebroplasty technique.


BACKGROUND
Viscous polymethylmethacrylate cement is frequently used to avoid leakage in vertebroplasty. However, the large force required to inject the cement can require the use of special equipment or the direct injection of the cement without a cannula. In addition, injection under fluoroscopic guidance with a short or absent cannula is associated with a higher intraoperative radiation dose. A method using an angiographic catheter for thin cement injection is presented.


METHODS
Real-time, fluoroscopy-controlled, catheter-assisted, thin cement injection was used for 102 vertebroplasty sessions (84 patients, 148 vertebrae). Leakage was monitored in 85 procedures via computed tomography.


RESULTS
All vertebral bodies were successfully and satisfactorily filled with bone cement. Cement leakage was evident in 50% of the 85 asymptomatic cases (25 paraspinal, 29 epidural, and 30 intradisc space). On follow-up, new compression fractures were noted in the same (n = 5) or adjacent (n = 16) vertebral body, and elsewhere (n = 10). Vertebroplasty provided pain relief in >90% of cases. Recurrent compression fracture occurred in 5 vertebrae of 4 patients after vertebroplasty. New compression fractures occurred in 16 adjacent vertebral bodies of 11 patients and in 10 vertebral bodies remote from the site. One patient who developed osteomyelitis was successfully treated with antibiotics alone.


CONCLUSIONS
Real-time, fluoroscopy-controlled, catheter-assisted, low-viscosity cement injection is a safe and feasible method for vertebroplasty, and produces a comparable outcome as high-viscosity cements.
Lee
Chung-Wei
CW
Department of Medical Imaging, National Taiwan University Hospital, Taipei.
Wang
Yao-Hung
YH
Liu
Hon-Man
HM
Chen
Ya-Fang
YF
Hsieh
Hung-Jen
HJ
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D002404:Catheterization; D005260:Female; D005471:Fluoroscopy; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000601:surgery*; D011109:Polymethacrylic Acids / Q000008:administration & dosage*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements; D011109:Polymethacrylic Acids; C030613:polymethacrylic acid