Percutaneous vertebroplasty and bone cement leakage: Clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures

Giovanni Carlo Anselmetti, Gregg Zoarski, Antonio Manca, Salvatore Masala, Haris Eminefendic, Filippo Russo, Daniele Regge

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Abstract

The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 ± 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p <0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p <0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p <0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

Original languageEnglish
Pages (from-to)937-947
Number of pages11
JournalCardioVascular and Interventional Radiology
Volume31
Issue number5
DOIs
Publication statusPublished - Sep 2008

Fingerprint

Vertebroplasty
Compression Fractures
Bone Cements
Polymethyl Methacrylate
Viscosity
Spine
Israel
Hemangioma
Nonparametric Statistics
Osteoporosis
Pain

Keywords

  • Bone metastases
  • Cement leakage
  • Osteoporosis
  • Polymethylmethacrylate
  • Spine
  • Vertebral fracture
  • Vertebroplasty

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{21170ab5447a4483a36583c70b63bc77,
title = "Percutaneous vertebroplasty and bone cement leakage: Clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures",
abstract = "The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 ± 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p <0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p <0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2{\%}) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1{\%}). In Group B, a venous leak was seen in 38 of 92 (41.3{\%}) and a discoidal leak in 12 of 92 (13.0{\%}). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p <0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.",
keywords = "Bone metastases, Cement leakage, Osteoporosis, Polymethylmethacrylate, Spine, Vertebral fracture, Vertebroplasty",
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T2 - Clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures

AU - Anselmetti, Giovanni Carlo

AU - Zoarski, Gregg

AU - Manca, Antonio

AU - Masala, Salvatore

AU - Eminefendic, Haris

AU - Russo, Filippo

AU - Regge, Daniele

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N2 - The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 ± 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p <0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p <0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p <0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

AB - The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 ± 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p <0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p <0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p <0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

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KW - Osteoporosis

KW - Polymethylmethacrylate

KW - Spine

KW - Vertebral fracture

KW - Vertebroplasty

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