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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

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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.

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Acknowledgment

The authors acknowledge Mrs. Olga Bruno for her kind and lovely collaboration.

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Authors and Affiliations

  1. Interventional Radiology Unit, Institute for Cancer Research and Treatment (IRCC), Strada Provinciale no. 142 km 3,95, Candiolo, Turin, 10060, Italy

    Giovanni Carlo Anselmetti

  2. Radiology and Radiological Science, University of Maryland, Baltimore, MD, USA

    Gregg Zoarski

  3. Radiology Unit, Institute for Cancer Research and Treatment (IRCC), Strada Provinciale no. 142 km 3,95, Candiolo, Turin, 10060, Italy

    Antonio Manca, Haris Eminefendic, Filippo Russo & Daniele Regge

  4. Radiology Unit and Interventional Radiology Unit, University “Tor Vergata”, Viale Oxford 81, Rome, 00133, Italy

    Salvatore Masala

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  1. Giovanni Carlo Anselmetti
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  2. Gregg Zoarski
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Correspondence to Giovanni Carlo Anselmetti.

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Anselmetti, G.C., Zoarski, G., Manca, A. et al. 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. Cardiovasc Intervent Radiol 31, 937–947 (2008). https://doi.org/10.1007/s00270-008-9324-6

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  • DOI: https://doi.org/10.1007/s00270-008-9324-6

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