[Intravertebral pressure during vertebroplasty - an in-vitro study].
BACKGROUND
Extravasation of bone cement into the vertebral venous system during cement injection has been reported to be a major complication of percutaneous vertebroplasty. Therefore, high injection pressures during cement application into the fractured vertebral body are considered as one possible cause of cement leakage or extravasation. The aim of the current study was to measure the increase in intravertebral pressure caused by cement injection during vertebroplasty compared to the baseline venous pressure for the ascending lumbar vene.


METHODS
In context of a cadaver study of 19 unfixed lumbar cadaver spines (L2-L5) [9 female, 10 male, 72 +/- 4.1 years] 19 vertebroplasties have been performed under operative conditions through a transpedicular approach. A manometer was placed in the lateral corticalis of each vertebral body for dynamic pressure measurement during 4 cement application cycles. Average and maximal intravertebral pressures as well as the average intravertebral pressure over the time of cement application ["area under the curve" (AUC)] were calculated.


RESULTS
Average intravertebral pressure (10.9 +/- 12.6 kPa [min.: - 15.2 +/- 24.7 kPa; max.: 56.1 +/- 70.1 kPa]) showed a 13.6-fold increase compared to the baseline venous pressure for the ascending lumbar vein and a 70-fold increase compared to maximal pressure. During the 4 cement application cycles a continuous increase of the average intravertebral pressure over the application cycle (AUC) occurred.


CONCLUSIONS
The 13.6-fold increase in intravertebral body pressure caused by cement injection during percutaneous vertebroplasty in comparison to the baseline venous pressure for the ascending lumbar vein might be one possible cause of the high rate of extravasation of bone cement reported in the current literature.
Gravius
S
S
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn. sascha.gravius@ukb.uni-bonn.de
Kraska
N
N
Maus
U
U
Mumme
T
T
Berdel
P
P
Weisskopf
M
M
D000368:Aged; D019540:Area Under Curve; D001843:Bone Cements; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000503:physiopathology*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007431:Intraoperative Complications / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008365:Manometry / Q000295:instrumentation*; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D014690:Venous Pressure / Q000502:physiology; D054854:Vertebroplasty / Q000295:instrumentation*
D001843:Bone Cements