Lavage prior to vertebral augmentation reduces the risk for cement leakage

Hoppe, Sven; El-Fiky, Tarek; Keel, Marius; Aghayev, Emin; Ecker, Timo M.; Benneker, Lorin Michael

doi:10.1007/s00586-015-4191-8

“…The surgical technique used in the current study is designed to minimize implant leakage by preparing the vertebral body prior to injection with saline lavage. This technique has been shown to significantly reduce leakage frequency while improving cement distribution within the vertebral body [15]. It is hypothesized that saline lavage removes marrow, fat, and soft tissue elements from the vertebral body, leading to a measurable decrease in pulmonary fat emboli during cement injection into a vertebral body [21].…”

Section: Discussionmentioning

confidence: 99%

“…Two 11G bone access cannulas were placed in the anterior half of the vertebral body through the pedicles. Saline lavage was performed as described by Hoppe et al by first attaching one 20 mL syringe containing 10 mL of saline to one access cannula while an empty 20 mL syringe was attached to the contralateral cannula [15]. A slight vacuum was then applied to the empty syringe as gentle pressure was applied to inject saline from the opposite syringe to pull marrow, fat, and soft tissue from the vertebral body.…”

Section: Treatment Proceduresmentioning

confidence: 99%

Local osteo-enhancement of osteoporotic vertebra with a triphasic bone implant material increases strength—a biomechanical study

Trost

¹

,

Schmoelz

²

,

Wimmer

³

et al. 2020

Arch Orthop Trauma Surg

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The aim of this study was to assess the biomechanical properties of intact vertebra augmented using a local osteoenhancement procedure to inject a triphasic calcium sulfate/calcium phosphate implant material. Methods Twenty-one fresh frozen human cadaver vertebra (Th11-L2) were randomized into three groups: treatment, sham, and control (n = 7 each). Treatment included vertebral body access, saline lavage to displace soft tissue and marrow elements, and injection of the implant material to fill approximately 20% of the vertebral body by volume. The sham group included all treatment steps, but without injection of the implant material. The control group consisted of untreated intact osteoporotic vertebra. Load at failure and displacement at failure for each of the three groups were measured in axial compression loading. Results The mean failure load of treated vertebra (4118 N) was significantly higher than either control (2841 N) or sham (2186 N) vertebra (p < 0.05 for: treatment vs. control, treatment vs. sham). Treated vertebra (1.11 mm) showed a significantly higher mean displacement at failure than sham vertebra (0.80 mm) (p < 0.05 for: treatment vs. sham). In the control group, the mean displacement at failure was 0.99 mm. Conclusions This biomechanical study shows that a local osteo-enhancement procedure using a triphasic implant material significantly increases the load at failure and displacement at failure in cadaveric osteoporotic vertebra.

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“…Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference…”

Section: Introductionmentioning

confidence: 99%

“…However, leakage during PVP or PKP remains a concern among surgeons. Some studies have shown that intravertebral lavage prior to cement injection can effectively remove vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7] .Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference…”

mentioning

confidence: 99%

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

Yan

¹

,

Liu

²

,

Zheng

³

et al. 2020

Preprint

0

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Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated.Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated.Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group.Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system. BackgroundPercutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) is effective in the treatment of osteoporotic vertebral compression fractures. These techniques can provide instant pain relief [1][2][3] and stabilize vertebral fracture [3][4][5] . However, leakage during PVP or PKP remains a concern among surgeons. Some studies have shown that intravertebral lavage prior to cement injection can effectively remove vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7] .Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet *Significant difference Leakage rateCement leakage was evaluated on the basis of the CT images. Cement leakage occurred in one (6.7%) of the irrigated specimens and in seven (46.7%) of the unirrigated ones (Table 1). Cement distributionCT images showed the distinct distributions of cement in the two groups. The bone cement mass was homogeneous and had more uniform density in the irrigated group than in the unirrigated group. The cement distribution of the unirrigated vertebrae was more irregular than that of the irrigated group (Fig.2). CMVThe Mann-Whitney U test results revealed smaller CMV in the irrigated group than in the unirrigated JY performed the experiments and participated in the design of the study. QL performed the experiments and wrote the manuscript. ZL, ...

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“…Some studies have shown that intravertebral lavage prior to cement injection can effectively remove vertebral fat and bone marrow and reduce the morbidity of extravasation [6,7] . Previously reported lavage methods involved bilateral operation [8,9,10] , but unilateral pulsed jet lavage method has not been described. Thus, we designed and used a unilateral pulsed jet lavage system to investigate the effect of unilateral irrigation prior to vertebroplasty on leakage, intravertebral pressure, and cement distribution.…”

Section: Introductionmentioning

confidence: 99%

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

Yan

¹

,

Liu

²

,

Zheng

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

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Lavage prior to vertebral augmentation reduces the risk for cement leakage

Abstract: 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.

Cited by 21 publications

References 36 publications

Local osteo-enhancement of osteoporotic vertebra with a triphasic bone implant material increases strength—a biomechanical study

Local osteo-enhancement of osteoporotic vertebra with a triphasic bone implant material increases strength—a biomechanical study

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

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