The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: an animal study.

Abstract

Percutaneous vertebroplasty, comprising of the injection of polymethylmethacrylate (PMMA) into vertebral bodies, is an efficient procedure to stabilize osteoporotic compression fractures as well as other weakening lesions. Besides fat embolism, cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the PMMA during injection plays a key role in this context. It was shown in vitro that the best way to lower the risk of cement leakage is to inject the cement at higher viscosity, which is requires high injection forces. Injection forces can be reduced by applying a newly developed lavage technique as it was shown in vitro using human cadaver vertebrae. The purpose of this study was to prove the in vitro results in an in vivo model. The investigation was incorporated in an animal study that was performed to evaluate the cardiovascular reaction on cement augmentation using the lavage technique. Injection forces were measured with instrumentation for 1 cc syringes, additionally acquiring plunger displacement. Averaged injection forces measured, ranged from 12 to 130 N and from 28 to 140 N for the lavage group and the control group, respectively. Normalized injection forces (by viscosity and injection speed) showed a trend to be lower for the lavage group in comparison to the control group (P = 0.073). In conclusion, the clinical relevance on the investigated lavage technique concerning lowering injection forces was only shown by trend in the performed animal study. However, it might well be that the effect is more pronounced for osteoporotic vertebral bodies.

• Authors: Andreas Boger, Lorin M Benneker, Jörg Krebs, Vanessa Boner, Paul F Heini, Armando Gisep
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 18 Issue 12 Pg. 1957-62 (Dec 2009) ISSN: 1432-0932 [Electronic] Germany
• PMID: 19568774 (Publication Type: Journal Article)

Chemical References

• Bone Cements
• Polymethyl Methacrylate

Topics

• Animals
• Biomechanical Phenomena (physiology)
• Bone Cements (adverse effects, chemistry, standards)
• Cardiovascular Diseases (chemically induced, physiopathology)
• Embolism, Fat (etiology, physiopathology, prevention & control)
• Female
• Foreign-Body Migration (etiology, physiopathology, prevention & control)
• Injections (instrumentation, methods)
• Models, Animal
• Osteoporosis (complications, physiopathology)
• Polymethyl Methacrylate (adverse effects, chemistry, standards)
• Postoperative Complications (etiology, physiopathology, prevention & control)
• Pressure (adverse effects)
• Sheep
• Therapeutic Irrigation (instrumentation, methods)
• Vertebroplasty (adverse effects, instrumentation, methods)
• Viscosity