title: Bone cement flow analysis by stepwise injection through medical cannulas.
abstract: Cement leakage is a serious adverse event potentially occurring during vertebroplasty. Pre-operative in-silico planning of the cement filling process can help reducing complication rates related to leakage. This requires a better understanding of the cement flow along the whole injection path. Therefore, the aim of the present study was to analyze bone cement flow behavior by stepwise injections through medical cannulas. Sixteen cannulas were assigned to four groups for stepwise injection of differently colored cement portions of 1ml volume. Each group differed in the amount of injected cement portions with a range of 1-4ml. After cement curing longitudinal cross-sections of the cannulas were performed and high-resolution pictures taken. Based on these pictures, quadratic polynomial interpolation was applied to the marked intersections between the last two injected cement portions to calculate the leading coefficients. Leading coefficients in the groups with three cement portions (0.287 ± 0.078), four portions (0.243 ± 0.041) and two portions (0.232 ± 0.050) were comparable and significantly higher than the group with one cement portion (0.0032 ± 0.0004), p ≤ 0.016. Based on these findings, cement flow through medical cannulas can be considered as predictable and can therefore be excluded as a source of risk for possible cement leakage complications during vertebroplasty procedures.
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland. Electronic address: ivan.zderic@aofoundation.org.
authors.forename: Ivan
authors.initials: I
authors.lastname: Zderic
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Steinmetz
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Windolf
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
authors.forename: R Geoff
authors.initials: RG
authors.lastname: Richards
authors.affiliation: Ansbach University of Applied Sciences, Residenzstrasse 8, 91552 Ansbach, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Boger
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
authors.forename: Boyko
authors.initials: B
authors.lastname: Gueorguiev
mesh_terms: D001843:Bone Cements; D000072601:Cannula; D007267:Injections; D055595:Mechanical Phenomena; D012306:Risk; D054854:Vertebroplasty; D014783:Viscosity
chemical_list: D001843:Bone Cements
keywords: Bone cement; Leakage; Medical cannulas; Vertebroplasty