title: Decompressed percutaneous vertebroplasty: a secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures.
abstract: The purpose of this study was to assess the efficacy of a new assistive procedure for injecting cement in percutaneous vertebroplasty (PV). Percutaneous vertebroplasty is frequently used for treating patients with osteoporotic vertebral compression fractures. However, the leakage of bone cement during PV may lead to serious complications, such as spinal cord compression or pulmonary embolism. Herein we present a secure procedure designed to safely and effectively deliver the bone cement into the vertebral column.
  
  
  METHODS
  Thirty-five patients with a total of 50 levels of osteoporotic compression fracture were consecutively recruited for the study. During a routine PV operation, acrylic cement was injected with a simultaneous application of a continuous negative pressure to the contralateral side of the vertebral body. This negative pressure exerts a pulling force that attracts the bone cement to flow within the vertebral body.
  
  
  RESULTS
  With the proposed decompressed PV procedure, cross-filling of the vertebrographies was achieved for all 50 fracture levels, with no paravertebral venous plexus leakage. Three of the 50 levels (6%) exhibited contrast-medium leakage into the intradisc or cortical defect regions. After decompressed cement injection, excellent cross-filling of bone cement deposition was achieved in 38 of the 50 levels (76%; cement cross-filling region >75%), good cross-filling deposition was achieved in 7 levels (14%; cement cross-filling region >50%), deposition was poor in 3 levels (6%; cement cross-filling region <50%), and deposition failed in 2 levels (4%; fixed cement with no sign of cross-filling). Routine postoperative reviews revealed that six fracture levels (12%) had minimal cement leakage, with two leaking into the disc and four into paravertebral cortical defect regions.
  
  
  CONCLUSIONS
  Compared to the reported 20-88% cement leakage rate for the conventional PV procedure, the proposed decompressed PV procedure offers a more secure and effective way to perform cement injection, and reduces the likelihood of cement leakage.
authors.affiliation: Institute of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan, ROC.
authors.forename: William
authors.initials: W
authors.lastname: Chu
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Tsuei
authors.forename: Pei-Hung
authors.initials: PH
authors.lastname: Liao
authors.forename: Jiun-Hung
authors.initials: JH
authors.lastname: Lin
authors.forename: Wen-Hsiang
authors.initials: WH
authors.lastname: Chou
authors.forename: Woei-Chyn
authors.initials: WC
authors.lastname: Chu
authors.forename: Shuenn-Tsong
authors.initials: ST
authors.lastname: Young
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects; D019299:Decompression, Surgical; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D013117:Spinal Cord Compression / Q000209:etiology / Q000517:prevention & control; D016103:Spinal Fractures / Q000601:surgery*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects / Q000379:methods
chemical_list: D001843:Bone Cements