Lower-Pressure Percutaneous Vertebroplasty Using Larger-Diameter Bone-Cement Fillers

Abstract

Study Design: This is a retrospective, case-controlled study Objective: We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). Summary of the Literature Review: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement. Materials and Methods: With excluding Kummell’s disease, 23 VCF’s were treated with LP-PVP using 2.8mm-diameter cement fillers, 51 VCF’s were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF’s were treated with C-PVP using 1.4mmdiameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year. Results: The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9±1.6ml for the LP-PVP, 5.9±1.9ml for the KP and 3.5±1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8±10.3%, 13.0±12.7% and 4.7±7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1±1.8%, 1.1±1.4% and 5.9±4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0±4.0°, 3.7±4.4° and 4.2±4.4°, respectively, in each group (p=0.528) with reduction loss of 1.0±0.9°, 0.1±1.7° and 3.5± 2.8°, respectively, in each group (p=0.000). There was a reduction of the regional Cobb’s angle by 4.3±2.6°, 3.1±4.7° and 2.9±3.8°, respectively, in each group (p=0.184) with a reduction loss of 3.6±4.5°, 0.1±1.5° and 1.0±4.1°, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP, in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030). Conclusion: The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.