Clinical Experience Using a Remote Control Injection System in Vertebroplasty: Feasibility, Safety, and Cement Leakage of Osteoporotic and Malignant Compression Fractures.

Abstract

A retrospective study. Cement leakage is a frequent occurrence in vertebroplasty and is also the main source of complications. Continuous radiographic evaluation is mandatory to detect cement leakage during injecting cement into the vertebral body, while the operator is subjected to x-ray radiation exposure. The aim of this study was to evaluate the feasibility and safety of vertebroplasty performed on patients and operators for the treatment of osteoporotic and malignant vertebral compression fractures using a remote control injection system. Institutional review board approval was obtained for this retrospective study. Clinical charts and postoperative radiographs were obtained for 74 patients (114 levels) who underwent vertebroplasty. The study group included 46 cases (71 levels) of benign osteoporotic fractures and 28 cases (43 levels) of different malignant metastatic lesions. Under fluoroscopic guidance, cement was injected using a remote control injection system, while the operator was standing outside the radiation field. The location and degree of leakage at each treated level were recorded. Cement leakage rate reached 47.4% across all treated levels. No severe leakage in any location was observed. A total of 35 leakages were detected in 71 levels and 24 leakages were detected in 43 levels in the benign and malignant fracture group, respectively. The overall rate of cement leakages and the location of the leakages were not statistically different between the benign and malignant fracture group (P=0.60, P=0.45). With the operator standing outside the radiation field to inject cement, the radiation dose to operators was avoided during cement injection. Vertebroplasty using a remote control injection system was feasible and safe in treatment of osteoporotic and malignant compression fractures. The cement injection system had potential benefits to decrease the leakage rate in treating malignant fractures and eliminate injection dose to operators under lateral fluoroscopic monitoring.