J Korean Soc Spine Surg.  2010 Sep;17(3):127-138. 10.4184/jkss.2010.17.3.127.

Lower-Pressure Percutaneous Vertebroplasty Using Larger-Diameter Bone-Cement Fillers

• Ahn DK
• Lee S
• Choi DJ
• Park HS
• Kim KS
• Chun TH

• KMID: 1459278
• DOI: http://doi.org/10.4184/jkss.2010.17.3.127

Abstract

STUDY DESIGN: This is a retrospective, case-controlled study.
OBJECTIVE
We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). SUMMARY OF THE LITERATURE REVIEW: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement.
MATERIALS AND METHODS
With excluding Kummell's disease, 23 VCF's were treated with LP-PVP using 2.8mm-diameter cement fillers, 51 VCF's were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF's were treated with C-PVP using 1.4mm-diameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year.
RESULTS
The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9+/-1.6ml for the LP-PVP, 5.9+/-1.9ml for the KP and 3.5+/-1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8+/-10.3%, 13.0+/-12.7% and 4.7+/-7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1+/-1.8%, 1.1+/-1.4% and 5.9+/-4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0+/-4.0degrees, 3.7+/-4.4degrees and 4.2+/-4.4degrees, respectively, in each group (p=0.528) with reduction loss of 1.0+/-0.9degrees, 0.1+/-1.7degrees and 3.5+/-2.8degrees, respectively, in each group (p=0.000). There was a reduction of the regional Cobb's angle by 4.3+/-2.6degrees, 3.1+/-4.7degrees and 2.9+/-3.8degrees, respectively, in each group (p=0.184) with a reduction loss of 3.6+/-4.5degrees, 0.1+/-1.5degrees and 1.0+/-4.1degrees, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP, in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030).
CONCLUSION
The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.

Keyword

Osteoporotic vertebral compression fracture; Lower-pressure percutaneous vertebroplasty

MeSH Terms

Biopsy
Case-Control Studies
Follow-Up Studies
Fractures, Compression
Needles
Retrospective Studies
Vertebroplasty
Viscosity

Figure

• 

  Fig. 1. LP-PVP. (A,B) L3 compression fracture was happened in 81-year old female patient. (C,D) The cement configuration in LP-PVP showed solid round mass with interdigitated margin. (E,F) One-year follow-up simple radiographs showed a little collapse to which degree the cement mass supported both endplates.

• 

  Fig. 2. KP. (A,B) L1 compression fracture was happened in 81-year old female patient. (C,D) The cement configuration in KP showed solid bead-like mass without interdigitation. Inadequately lower-viscous cement injection caused extravasation despite of vacant space made by ballooning. (E,F) Even though collapse of the augmented vertebra, sufficient amount of cement could support both endplates.

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  Fig. 3. C-PCP. (A,B) L1 compression fracture was happened in 65-year old female patient. (C,D) The cement configuration showed dispersion into cancellous bone with interdigitation-like appearance. (E,F) One-year follow-up AP radiograph showed a weak support of only the upper endplate rather than lateral view because of small amount of cement injection.

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