New Development in VCFs Treatment: Vesselplasty, Vessel-Lock, and SrHA Cement

Abstract

Introduction Vertebroplasty and kyphoplasty are used to treat VCFs with a risk of certain cement leakage. Regarding cement leakage the new technique vesselplasty use a nonstretchable PET container to prevent leakage of the injected cement and then left as an implant body expander. Instead of PMMA, the new SrHA cement (osteoinductive and osteoconductive with less 65°C heat production) is to be used. To treat a complex case (osteoporotic VCFs, multiple stenosis, and kyphotic and degenerative scoliosis), the new innovative vessel-lock system is used. The purpose of this study is to review the theory, surgical techniques, 5 years results using this new technique and compare the effect of SrHA and PMMA cement in osteoporotic bone. Materials and Methods A nonrandomized prospective study to treat VCFs using vesselplasty with PMMA and SrHA cement. This new technique, the Vessel-X system is a percutaneous nonfusion technique to stabilize, restore VCFs, and prevent leakage risk of cement. Instead of previously creating a void inside the vertebral body to be filled with BFMs, this system allows the delivery of a nonstretchable bone filler container (BFC) into the vertebral body in deflated configuration, then inflated by injecting viscous BFMs into the BFC, and left as an implant body expander. The volume of the injected BFMs is controlled by a controllable cement delivery (CCD) injector system with extension tube. The pressure inside the BFC is created by the resistance of the polyethylene terephthalate (PET) container which is related to the amount of layers (1 or 2 layers), the pore size 100 µm, and the container size. The optimum pressure need to lift the end plate is the amount of pressure to counteract the resistance of surrounding bone density (fresh or old fractures, young or elderly patients), and related to the amount of BFMs to be injected with pressure into a certain size of BFC. When the pressure is over the surrounding bone resistance, the BFMs stars to penetrate the pores and interdigitate, thus stabilizing the BFC to the surrounding bone. Compare the effect of SrHA and PMMA using X-ray and CT scan: just after treatment, 3 months and 6 months after treatment. Results A total of 250 cases consist of 298 VCFs (VT3-VL 5) that have been treated using this new technique included 178 PMMA and 120 SrHA cases is reported also the five preliminary report of vessel-lock system. Conclusion The vesselplasty is a new technique to treat osteoporotic vertebral fractures using BFC system. This technique allows the stabilization and restoration of vertebral body height of VCFs, with the advantage in controlling the volume of the injected BFMs, also the pressure inside BFC, and preventing the leakage of BFMs. SrHA cement is superior compared with PMMA in the elderly cases. The vessel lock could be the solving of difficult cases. But there is still a continuum of osteoporotic problems that should be treated with a specific medical treatment. Disclosure of Interest None declared