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Lavage prior to vertebral augmentation reduces the risk for cement leakage

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Abstract

Purpose

This study aimed at assessing the cement leakage rate and the filling pattern in patients treated with vertebroplasty, kyphoplasty and stentoplasty with and without a newly developed lavage technique.

Study design

Retrospective clinical case–control study.

Methods

A newly developed bipedicular lavage technique prior to cement application was applied in 64 patients (45.1 %) with 116 vertebrae, (“lavage” group). A conventional bipedicular cement injection technique was used in 78 patients (54.9 %) with 99 levels (“controls”). The outcome measures were filling patterns and leakage rates.

Results

The overall leakage rate (venous, cortical defect, intradiscal) was 37.9 % in the lavage and 83.8 % in the control group (p < 0.001). Venous leakage (lavage 12.9 % vs. controls 31.3 %; p = 0.001) and cortical defect leakage (lavage 17.2 % vs. controls 63.3 %; p < 0.001) were significantly lower in the lavage group compared to “controls,” whereas intradiscal leakages were similar in both groups (lavage 12.1 % vs. controls 15.2 %; p = 0.51). For venous leakage multivariate logistic regression analysis showed lavage to be the only independent predictor. Lavage was associated with 0.33-times (95 % CI 0.16–0.65; p = 0.001) lower likelihood for leakage in compared to controls.

Conclusions

Vertebral body lavage prior to cement augmentation is a safe technique to reduce cement leakage in a clinical setting and has the potential to prevent pulmonary fat embolism. Moreover, a better filling pattern can be achieved.

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Author notes

    Authors and Affiliations

    1. Department for Orthopedic Surgery, Spine Unit, Inselspital, University Hospital of Bern, 3010, Bern, Switzerland

      Sven Hoppe, Marius Johann Baptist Keel, Timo Michael Ecker & Lorin Michael Benneker

    2. Spine Surgery Unit, El-Hadra University Hospital, Alexandria University, Alexandria, Egypt

      Tarek Elfiky

    3. Institute for Evaluative Research in Medicine, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

      Emin Aghayev

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    1. Sven Hoppe
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    Correspondence to Sven Hoppe.

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    S. Hoppe and T. Elfiky have equally contributed to the paper.

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    Hoppe, S., Elfiky, T., Keel, M.J.B. et al. Lavage prior to vertebral augmentation reduces the risk for cement leakage. Eur Spine J 25, 3463–3469 (2016). https://doi.org/10.1007/s00586-015-4191-8

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    • DOI: https://doi.org/10.1007/s00586-015-4191-8

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