Reduction of cement leakage by sequential PMMA application in a vertebroplasty model

Hoppe, Sven; Wangler, Sebastian; Aghayev, Emin; Gantenbein, Benjamin; Boger, Andreas; Benneker, Lorin Michael (2016). Reduction of cement leakage by sequential PMMA application in a vertebroplasty model. European spine journal, 25(11), pp. 3450-3455. Springer 10.1007/s00586-015-3920-3

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PURPOSE

Leakage is the most common complication of percutaneous cement augmentation of the spine. The viscosity of the polymethylmethacrylate (PMMA) cement is strongly correlated with the likelihood of cement leakage. We hypothesized that cement leakage can be reduced by sequential cement injection in a vertebroplasty model.

METHODS

A standardized vertebral body substitute model, consisting of aluminum oxide foams coated by acrylic cement with a preformed leakage path, simulating a ventral vein, was developed. Three injection techniques of 6 ml PMMA were assessed: injection in one single step (all-in-one), injection of 1 ml at the first and 5 ml at the second step with 1 min latency in-between (two-step), and sequential injection of 0.5 ml with 1-min latency between the sequences (sequential). Standard PMMA vertebroplasty cement was used; each injection type was tested on ten vertebral body substitute models with two possible leakage paths per model. Leakage was assessed by radiographs using a zonal graduation: intraspongious = no leakage and extracortical = leakage.

RESULTS

The leakage rate was significantly lower in the "sequential" technique (2/20 leakages) followed by "two-step" (15/20) and "all-in-one" (20/20) techniques (p < 0.001). The RR for a cement leakage was 10.0 times higher in the "all-in-one" compared to the "sequential" group (95 % confidence intervals 2.7-37.2; p < 0.001).

CONCLUSIONS

The sequential cement injection is a simple approach to minimize the risk for leakage. Taking advantage of the temperature gradient between body and room temperature, it is possible to increase the cement viscosity inside the vertebra while keeping it low in the syringe. Using sequential injection of small cement volumes, further leakage paths are blocked before further injection of the low-viscosity cement.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Hoppe, Sven, Aghayev, Emin, Benneker, Lorin Michael

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0940-6719

Publisher:

Springer

Language:

English

Submitter:

Fabian Röthlisberger

Date Deposited:

22 Mar 2016 09:30

Last Modified:

05 Dec 2022 14:51

Publisher DOI:

10.1007/s00586-015-3920-3

PubMed ID:

25841359

BORIS DOI:

10.7892/boris.75688

URI:

https://boris.unibe.ch/id/eprint/75688

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