Lavage prior to vertebral augmentation reduces the risk for cement leakage.
This study aimed at assessing the cement leakage rate and the filling pattern in patients treated with vertebroplasty, kyphoplasty and stentoplasty with and without a newly developed lavage technique.



Retrospective clinical case-control study.



A newly developed bipedicular lavage technique prior to cement application was applied in 64 patients (45.1 %) with 116 vertebrae, ("lavage" group). A conventional bipedicular cement injection technique was used in 78 patients (54.9 %) with 99 levels ("controls"). The outcome measures were filling patterns and leakage rates.



The overall leakage rate (venous, cortical defect, intradiscal) was 37.9 % in the lavage and 83.8 % in the control group (p < 0.001). Venous leakage (lavage 12.9 % vs. controls 31.3 %; p = 0.001) and cortical defect leakage (lavage 17.2 % vs. controls 63.3 %; p < 0.001) were significantly lower in the lavage group compared to "controls," whereas intradiscal leakages were similar in both groups (lavage 12.1 % vs. controls 15.2 %; p = 0.51). For venous leakage multivariate logistic regression analysis showed lavage to be the only independent predictor. Lavage was associated with 0.33-times (95 % CI 0.16-0.65; p = 0.001) lower likelihood for leakage in compared to controls.



Vertebral body lavage prior to cement augmentation is a safe technique to reduce cement leakage in a clinical setting and has the potential to prevent pulmonary fat embolism. Moreover, a better filling pattern can be achieved.
Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland. svenhoppe@gmail.com.
Sven
S
Hoppe
Spine Surgery Unit, El-Hadra University Hospital, Alexandria University, Alexandria, Egypt.
Tarek
T
Elfiky
Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland.
Marius Johann Baptist
MJ
Keel
Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland.
Emin
E
Aghayev
Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland.
Timo Michael
TM
Ecker
Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland.
Lorin Michael
LM
Benneker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D016022:Case-Control Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control*; D005260:Female; D050815:Fractures, Compression / Q000601:surgery; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery; D007507:Therapeutic Irrigation; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements
Balloon kyphoplasty; Complication; Lavage; Leakage; PMMA; Vertebroplasty