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

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...

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Bibliographic Details
Published in:	Journal of orthopaedic surgery and research 2020-07, Vol.15 (1), p.259-259, Article 259
Main Authors:	Yan, Jun, Liu, Qiaohui, Zheng, Yanping, Liu, Ziqun, Liu, Xinyu, Guo, Xun, Liu, Penghui, Chen, Peng, Yuan, Suomao, Tian, Yonghao, Xu, Wanlong
Format:	Article
Language:	eng
Subjects:	Aged Biopsy Bone Cements - adverse effects Bone density Bone implants Bone marrow Bone surgery Camcorders Cameras Care and treatment CAT scans Cement Cement distribution Compression Computed tomography Female Fractures, Compression - surgery Humans Injection Intravertebral pressure Irrigation Lavage Leakage Lumbar Vertebrae - surgery Male Medical imaging Middle Aged Morbidity Orthopedic surgery Osteoporosis Osteoporotic Fractures - surgery Percutaneous vertebroplasty Postoperative Complications - etiology Postoperative Complications - prevention & control Povidone Preoperative Care - methods Pressure Spinal Fractures - surgery Studies Therapeutic Irrigation - methods Unilateral pulsed jet lavage Vertebra Vertebrae Vertebroplasty - adverse effects Vertebroplasty - methods
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Summary:	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. 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. During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92 kPa versus 2.22 kPa, P < 0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm vs. 4344 mm , P < 0.05) and less leakage rate (6.7% vs. 46.7%, P < 0.05) in the irrigated group than in the control group. 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.
ISSN:	1749-799X 1749-799X