Minim Invasive Neurosurg 2008; 51(3): 187-191
DOI: 10.1055/s-2008-1073134
Technical Note

© Georg Thieme Verlag KG Stuttgart · New York

Modified Vertebroplasty using a Curved Probe: Technique and Preliminary Results

Y. J. Kwon 1
  • 1Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Further Information

Publication History

Publication Date:
02 June 2008 (online)

Abstract

Objective: One of the main limitations of vertebroplasty is the excessive pressure required for injection of sufficient cement into a vertebral body. Kyphoplasty can be used to reduce injection pressure by making a void with a balloon tamp. The author presents a technique of making small voids to reduce cement delivery pressure during vertebroplasty that involves a simple modification of the conventional technique.

Methods: The author performed this modified vertebroplasty in 48 patients with an acute vertebral compression fracture. Small voids and micro-connections with the fracture gaps in the vertebral body were created using a curved probe placed into the vertebral body through a working cannula. Visual analogue scale (VAS) scores were measured preoperatively and at 1 week and 3 months postoperatively. Forty patients with osteoporotic VCFs were followed for a mean period of 6months.

Results: All 48 patients showed a significant reduction in visual analogue pain scores at 1 week and 3 months postoperatively versus preoperative levels (p<0.001, respectively). No device-related complications or major cement leakages that caused postoperative neurological deficits or pulmonary complications were noted.

Conclusion: The described modification of vertebroplasty involving the creation of small cavities using a curved probe appears to control cement injection easily during the procedures and minimize cement leakage-related complications.

References

  • 1 Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty.  Neurochirurgie. 1987;  33 166-168
  • 2 Yeom JS, Kim WJ, Choy WS. et al . Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures.  J Bone Joint Surg [Br]. 2003;  85 83-89
  • 3 Al-Assir I, Perez-Higueras A, Florensa J, Munoz A, Cuesta E. Percutaneous vertebroplasty: a special syringe for cement injection.  AJNR Am J Neuroradiol. 2000;  21 159-161
  • 4 Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures.  Spine. 2003;  28 S45-S53
  • 5 Phillips FM, Ho E, Campbell-Hupp M. et al . Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.  Spine. 2003;  28 2260-2265 , ; discussion 2265-2267
  • 6 Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of „kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures.  Spine. 2001;  26 1631-1638
  • 7 Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report.  Spine. 2002;  27 E419-E422
  • 8 Ratliff J, Nguyen T, Heiss J. Root and spinal cord compression from methylmethacrylate vertebroplasty.  Spine. 2001;  26 E300-E302
  • 9 Jang JS, Lee SH, Jung SK. Pulmonary embolism of polymethyl methacrylate after percutaneous vertebroplasty: a report of three cases.  Spine. 2002;  27 E416-E418
  • 10 Chen HL, Wong CS, Ho ST. et al . A lethal pulmonary embolism during percutaneous vertebroplasty.  Anesth Analg. 2002;  95 1060-1062 , (table of contents)
  • 11 Cortet B, Cotten A, Boutry N. et al . Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.  J Rheumatol. 1999;  26 2222-2228
  • 12 Tsou IY, Goh PY, Peh WC, Goh LA, Chee TS. Percutaneous vertebroplasty in the management of osteoporotic vertebral compression fractures: initial experience.  Ann Acad Med Singapore. 2002;  31 15-20
  • 13 Gaughen  Jr  JR, Jensen ME, Schweickert PA. et al . Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures.  AJNR Am J Neuroradiol. 2002;  23 594-600
  • 14 Belkoff SM, Mathis JM, Fenton DC. et al . An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture.  Spine. 2001;  26 151-156
  • 15 Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.  Spine. 2001;  26 1511-1515
  • 16 Ledlie JT, Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels.  J Neurosurg. 2003;  98 36-42
  • 17 Phillips FM, Todd Wetzel F, Lieberman I, Campbell-Hupp M. An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty.  Spine. 2002;  27 2173-2178 , ; discussion 2178-2179
  • 18 Nussbaum DA, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site.  J Vasc Interv Radiol. 2004;  15 1185-1192
  • 19 Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures.  Clinical imaging. 2002;  26 1-5
  • 20 Ortiz AO, Zoarski GH, Beckerman M. Kyphoplasty.  Techniques in vascular and interventional radiology. 2002;  5 239-249
  • 21 Baroud G, Steffen T. A new cannula to ease cement injection during vertebroplasty.  Eur Spine J. 2005;  14 474-479
  • 22 Vallejo R, Benyamin R, Floyd B. et al . Percutaneous cement injection into a created cavity for the treatment of vertebral body fracture: preliminary results of a new vertebroplasty technique.  Clin J Pain. 2006;  22 182-189
  • 23 Lee ST, Chen JF. A syringe compressor for vertebroplasty: technical note.  Surg Neurol. 2004;  61 580-584

Correspondence

Y.J. KwonMD, PhD 

Department of Neurosurgery

Kangbuk Samsung Hospital

Sungkyunkwan University School of Medicine

108 Pyung-Dong

Jongno-Ku

Seoul 110-746

South Korea

Phone: +82/2/2001 24 50

Fax: +82/2/2001 21 57

Email: neuriac@skku.edu

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