Sven Hoppe1, Tarek Elfiky2, Marius Johann Baptist Keel3, Emin Aghayev4, Timo Michael Ecker3, Lorin Michael Benneker3. 1. Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland. svenhoppe@gmail.com. 2. Spine Surgery Unit, El-Hadra University Hospital, Alexandria University, Alexandria, Egypt. 3. Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland. 4. Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland.
Abstract
PURPOSE: This study aimed at assessing the cement leakage rate and the filling pattern in patients treated with vertebroplasty, kyphoplasty and stentoplasty with and without a newly developed lavage technique. STUDY DESIGN: Retrospective clinical case-control study. METHODS: A newly developed bipedicular lavage technique prior to cement application was applied in 64 patients (45.1 %) with 116 vertebrae, ("lavage" group). A conventional bipedicular cement injection technique was used in 78 patients (54.9 %) with 99 levels ("controls"). The outcome measures were filling patterns and leakage rates. RESULTS: The overall leakage rate (venous, cortical defect, intradiscal) was 37.9 % in the lavage and 83.8 % in the control group (p < 0.001). Venous leakage (lavage 12.9 % vs. controls 31.3 %; p = 0.001) and cortical defect leakage (lavage 17.2 % vs. controls 63.3 %; p < 0.001) were significantly lower in the lavage group compared to "controls," whereas intradiscal leakages were similar in both groups (lavage 12.1 % vs. controls 15.2 %; p = 0.51). For venous leakage multivariate logistic regression analysis showed lavage to be the only independent predictor. Lavage was associated with 0.33-times (95 % CI 0.16-0.65; p = 0.001) lower likelihood for leakage in compared to controls. CONCLUSIONS: Vertebral body lavage prior to cement augmentation is a safe technique to reduce cement leakage in a clinical setting and has the potential to prevent pulmonary fat embolism. Moreover, a better filling pattern can be achieved.
PURPOSE: This study aimed at assessing the cement leakage rate and the filling pattern in patients treated with vertebroplasty, kyphoplasty and stentoplasty with and without a newly developed lavage technique. STUDY DESIGN: Retrospective clinical case-control study. METHODS: A newly developed bipedicular lavage technique prior to cement application was applied in 64 patients (45.1 %) with 116 vertebrae, ("lavage" group). A conventional bipedicular cement injection technique was used in 78 patients (54.9 %) with 99 levels ("controls"). The outcome measures were filling patterns and leakage rates. RESULTS: The overall leakage rate (venous, cortical defect, intradiscal) was 37.9 % in the lavage and 83.8 % in the control group (p < 0.001). Venous leakage (lavage 12.9 % vs. controls 31.3 %; p = 0.001) and cortical defect leakage (lavage 17.2 % vs. controls 63.3 %; p < 0.001) were significantly lower in the lavage group compared to "controls," whereas intradiscal leakages were similar in both groups (lavage 12.1 % vs. controls 15.2 %; p = 0.51). For venous leakage multivariate logistic regression analysis showed lavage to be the only independent predictor. Lavage was associated with 0.33-times (95 % CI 0.16-0.65; p = 0.001) lower likelihood for leakage in compared to controls. CONCLUSIONS: Vertebral body lavage prior to cement augmentation is a safe technique to reduce cement leakage in a clinical setting and has the potential to prevent pulmonary fat embolism. Moreover, a better filling pattern can be achieved.
Authors: Sven Hoppe; Sebastian Wangler; Emin Aghayev; Benjamin Gantenbein; Andreas Boger; Lorin M Benneker Journal: Eur Spine J Date: 2015-04-05 Impact factor: 3.134
Authors: Lars Hübschle; Fredrik Borgström; Gylfi Olafsson; Christoph Röder; Patrick Moulin; Albrecht W Popp; Fabrice Külling; Emin Aghayev Journal: Spine J Date: 2013-12-27 Impact factor: 4.166