title: Percutaneous Vertebroplasty: A New Serial Injection Technique to Minimize Cement Leak.
abstract: METHODS
  This is a prospective cohort study.
  
  
  OBJECTIVE
  This study discusses a new technique for injecting cement in the affected vertebrae.
  
  
  BACKGROUND
  Since introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation occurred in 26%-97% of the cases.
  
  
  METHODS
  A hundred and twenty-three patients underwent vertebroplasty using the serial injection technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection consisted of 1-1.5 mL of cement.
  
  
  RESULTS
  This new technique gives the surgeon enough time to make multiple separate injections using the same package. The time interval between injections hardens the cement just enough so that it does not get displaced by the next cement injection. This technique gives time to the preceding injected cement to seal off the cracks and cavities in the vertebra, and subsequently leads to a significant decrease in cement leak (p<0.001), as compared to literature.
  
  
  CONCLUSIONS
  This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also makes the surgeon more relaxed due to time intervals, giving him more self-confidence whilst performing the procedure.
authors.affiliation: Neurosurgical Department, Faculty of Medicine, Menoufia University Hospital, Shebin El Kom, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Elnoamany
keywords: Cement leak; Osteoporotic spinal fractures; Percutaneous vertebroplasty; Serial cement injection technique; Traumatic non osteoporotic vertebral fractures