VESSELPLASTY: A NOVEL CONCEPT OF PERCUTANEOUS TREATMENT FOR STABILIZATION AND HEIGHT RESTORATION OF VERTEBRAL COMPRESSION FRACTURES

Abstract

Objective: Vertebroplasty, kyphoplasty, VEX-3000, SKy bone expander, arcuplasty, and OptiMesh systems are methods of percutaneous osteoplasty (molding of the bone) to treat symptomatic vertebral compression fractures (VCFs) by injection of bone filler materials (BFMs) such as polymethyl methacrylate (PMMA), other kinds of bone cement, and bone grafts (autografts/allografts) or different kinds of osteoinductive/osteoconductive materials. A common risk in performing the abovementioned techniques is leakage of BFMs. The purpose of this technical consideration of vesselplasty was to review the theory, the surgical technique for stabilization and restoration of the height of VCFs, and the prevention of leakage, using a novel bone filler container (BFC) system. Methods: This novel concept of BFC highlights the Vessel-X™ system (A-Spine Holding, Taipei, Taiwan) as an evolution of the percutaneous osteoplasty technique to stabilize and restore VCFs and to prevent leakage risk. Instead of previously creating a void inside the vertebral body to be filled with BFMs, this system allows the delivery of a nonstretchable BFC into the vertebral body in deflated configuration, to be inflated by injecting viscous BFMs into the BFC, then left as an implant and acting as a vertebral body expander. The volume of the injected BFMs is controlled by a controllable cement delivery (CCD) injector system. The pressure inside the BFC is created by the resistance of the polyethylene terephthalate (PET) container, which is related to the number of layers (one or two layers), the pore size (100 μm), and the container size itself. The optimum pressure needed to lift the endplate is the amount of pressure required to counteract the resistance of the surrounding bone density (fresh or old fractures, young or elderly patients) and the large bending moment due to kyphotic deformity of the spine. The pressure is also related to the amount of BFMs to be injected into a certain size of the BFC. When the pressure is higher than the surrounding bone resistance, BFMs start to penetrate, interdigitate, and stabilize the BFC to the surrounding bone. Conclusions: The vesselplasty technique using the novel concept of BFC allows stabilization and restoration of VCF height, with the added advantages of controlling the volume of the injected BFMs, the pressure inside the BFC, and the leakage risk of BFMs as well as creating a gradual stiffness of BFMs inside the bone from the periphery to the central area.