Abstract
BackgroundFor osteoporosis or spinal metastases, percutaneous vertebroplasty is effective in pain relief and improvement of mobility. However, the complication rate (cement extravasation and fat embolisms) is relatively higher in the treatment of spinal metastases. The presence of tumor tissue plays a significant role in intravertebral pressure and cement distribution and thereby affects the occurrence of complications. We investigated the effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in spinal metastases.MethodsEighteen vertebrae (T8–L4) from five cadaveric spines were randomly allocated for two groups (group with and without void) of nine vertebrae each. Defect was created by removing a central core of cancellous bone in the vertebral body and then filling it with 30% or 100% fresh muscle paste by volume to simulate void creation or no void creation, respectively. Then, 20% bone cement by volume of the vertebral body was injected into each specimen through a unipedicular approach at a rate of 3 mL/min. The gender of the donor, vertebral body size, bone density, cement volume, and intravertebral pressure were recorded. Then, computed tomography scans and cross sections were taken to evaluate the cement distribution in vertebral bodies.ResultsNo significant difference was found between the two groups in terms of the gender of the donor, vertebral body size, bone density, or bone cement volume. The average maximum intravertebral pressure in the group with void creation was significantly lower than that in the group without void creation (1.20 versus 5.09 kPa, P = 0.001). Especially during the filling of void, the difference was more pronounced. Void creation prior to vertebroplasty allowed the bone cement to infiltrate into the lytic defect.ConclusionsIn vertebroplasty for spinal metastases, void creation produced lower intravertebral pressure and facilitated cement filling. To reduce the occurrence of complication, it may be an alternative to eliminate the tumor tissue to create a void prior to cement injection.
Highlights
For osteoporosis or spinal metastases, percutaneous vertebroplasty is effective in pain relief and improvement of mobility
There was no significant difference between the two groups in terms of the gender of the donor, vertebral body volume, bone density, or volume of bone cement (Table 1)
While the intravertebral pressure increased over the course of cement injection generally in both groups, the pressure remained very low until the filling of void was completed in specimens with a void
Summary
For osteoporosis or spinal metastases, percutaneous vertebroplasty is effective in pain relief and improvement of mobility. The complication rate (cement extravasation and fat embolisms) is relatively higher in the treatment of spinal metastases. The presence of tumor tissue plays a significant role in intravertebral pressure and cement distribution and thereby affects the occurrence of complications. We investigated the effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in spinal metastases. Studies have revealed that PVP is effective for spinal metastases in pain relief and improvement of mobility [9,10,11]. The presence of tumor tissue in the vertebral body contributes to a higher intravertebral pressure and unsatisfactory cement distribution [17]. It is necessary to explore a method to reduce the adverse effects of tumor tissue and investigate the underlying basis of the method in vertebroplasty
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