title: Sacroplasty procedural extravasation with high viscosity bone cement: comparing the intraoperative long-axis versus short-axis techniques in osteoporotic cadavers.
abstract: BACKGROUND
  Percutaneous sacroplasty involves image-guided injection of bone cement for sacral insufficiency fractures to alleviate pain and facilitate mobility. Correct sacral placement of the cement and the risk of cement extravasation present procedural challenges. This study compares the occurrence, number, location, and surface area of high viscosity radiopaque bone cement extravasation via biplane fluoroscopy with Dyna CT between the fluoroscopically-guided intraoperative long-axis and short-axis sacroplasty techniques in osteoporotic cadavers.
  
  
  METHODS
  Ten osteoporotic cadavers underwent bilateral percutaneous instillation of VertaPlex HV High Viscosity Radiopaque Bone Cement. Long- and short-axis sacroplasty techniques were randomly assigned to zone 1 of the left or right sacral ala of each cadaver. Cement extravasation data were summarized by technique (long-axis vs short-axis) and time period (15-min and 3-hour post-procedure syngo DynaCT scan) in the form of point and CI estimates for the true proportions of cement extravasation.
  
  
  RESULTS
  No procedural sacral extravasation differences were observed between the long-axis and short-axis sacroplasty techniques. There were no occurrences of intra-procedural or post-procedural cement extravasation at 15 min or 3 hours in association with either the long-axis sacroplasty technique or the short-axis sacroplasty technique.
  
  
  CONCLUSIONS
  The long- and short-axis sacroplasty techniques, using high viscosity cement with careful post-procedural positioning, result in no occurrence of cement extravasation in porous osteoporotic cadaver bone.
authors.affiliation: Bronson Neuroscience Center (Department of Neurosurgery), Bronson Neuroscience Research, Kalamazoo, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Miller
authors.affiliation: Stryker Instruments, Kalamazoo, USA.
authors.forename: Art
authors.initials: A
authors.lastname: Diani
authors.affiliation: Stryker Instruments, Kalamazoo, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Docsa
authors.affiliation: Stryker Instruments, Kalamazoo, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Ashton
authors.affiliation: Center for Clinical Research Solutions, Inc., Kalamazoo, Michigan, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Sciamanna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D002102:Cadaver; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D054854:Vertebroplasty / Q000379:methods*; D014783:Viscosity
chemical_list: D001843:Bone Cements
keywords: CT; Device; Technique