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Skeletal Radiology

, Volume 42, Issue 1, pp 79–84 | Cite as

Intravertebral pressure gradient during vertebroplasty

  • Markus WeisskopfEmail author
  • Oliver Miltner
  • Uwe Maus
  • Sascha Gravius
  • Jörg Axel Karl Ohnsorge
Scientific Article

Abstract

Objective

Intravertebral pressure (IP) is considered a possible factor influencing cement leakage in vertebroplasty (VP). Reports of measuring IP during the injection of the cement reveal rather low values in the periphery of the vertebral body but fail to determine the situation in the center. Hypothesizing there is a significant IP gradient between both areas intravertebral pressure measurements were conducted in a comparative biomechanical study.

Methods

VP was performed in ten lumbar cadaveric spines. A pressure sensor was either placed in the center or in the periphery of the vertebral body, while bone cement was delivered in 1.5-cc increments. Volume flow, cement mixing time, and room temperature were standardized and kept constant during cement injection.

Results

During the administration of the first 1.5 cc of bone cement, the central IP (C-IP) increased to 23.6 kPa and the peripheral IP (P-IP) to 0.9 kPa on average. With the second injection, the mean C-IP was 42.8 kPa while the mean P-IP was 3.8 kPa. During the 3rd filling, C-IP averaged 69.9 kPa and P-IP 12.8 kPa, respectively. At the last increment, C-IP was at 70.7 kPa and P-IP at 24.5 kPa on average.

Conclusions

A centroperipheral IP gradient (∆IP) was monitored during cement delivery in VP. ∆IP decreases with increasing bone cement charge of the vertebra, but C-IP stays significantly higher than P-IP at all times. C-IP was consistently higher than IP values reported for VP so far.

Keywords

Vertebroplasty Intravertebral pressure Cement leakage 

References

  1. 1.
    Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine. 2000;25:923–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Fourney DR, Schomer DF, Nader R, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98:21–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J. 2008;8(3):488–97.PubMedCrossRefGoogle Scholar
  4. 4.
    Hulme PA, Krebs J, Ferguson SJ, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine. 2006;31(17):1983–2001.PubMedCrossRefGoogle Scholar
  5. 5.
    Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998;36:533–46.PubMedCrossRefGoogle Scholar
  6. 6.
    Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures. Am J Neuroradiol. 1997;18:1897–904.PubMedGoogle Scholar
  7. 7.
    Taylor RS, Taylor RJ, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine. 2006;31(23):2747–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br. 2003;85(1):83–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Baroud G, Vant C, Giannitsios D, Bohner M, Steffen T. Effect of vertebral shell on injection pressure and intravertebral pressure in vertebroplasty. Spine. 2004;30:68–74.Google Scholar
  10. 10.
    Krebs J, Ferguson SJ, Bohner M, Baroud G, Steffen T, Heini PF. Clinical measurements of cement injection pressure during vertebroplasty. Spine. 2005;30:E118–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Weisskopf M, Ohnsorge JA, Niethard FU. Intravertebral pressure during vertebroplasty and balloon kyphoplasty: an in vitro study. Spine. 2008;33(2):178–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Aebli N, Krebs J, Schwenke D, Davis G, Theis JC. Pressurization of vertebral bodies during vertebroplasty causes cardiovascular complications: an experimental study in sheep. Spine. 2003;28:1513–20.PubMedGoogle Scholar
  13. 13.
    Reidy D, Ahn H, Mousavi P, Finkelstein J, Whyne CM. A biomechanical analysis of intravertebral pressures during vertebroplasty of cadaveric spines with and without simulated metastases. Spine. 2003;28:1534–9.PubMedGoogle Scholar
  14. 14.
    Tomita S, Molloy S, Abe M, Belkoff SM. Ex vivo measurement of intravertebral pressure during vertebroplasty. Spine. 2004;29:723–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Georgy BA. Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation: occurrence, degree, and location of cement leakage compared with kyphoplasty. Am J Neuroradiol. 2010;31(3):504–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Anselmetti GC, Zoarski G, Manca A, et al. Percutaneous vertebroplasty and bone cement leakage: clinical experience with a new high-viscosity bone cement and delivery system for vertebral augmentation in benign and malignant compression fractures. Cardiovasc Intervent Radiol. 2008;31(5):937–47.PubMedCrossRefGoogle Scholar
  17. 17.
    Loeffel M, Ferguson SJ, Nolte LP, Kowal JH. Vertebroplasty: experimental characterization of polymethylmethacrylate bone cement spreading as a function of viscosity, bone porosity, and flow rate. Spine. 2008;33(12):1352–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Nieuwenhuijse MJ, Muijs SP, van Erkel AR, Dijkstra SP. A clinical comparative study on low versus medium viscosity polymethylmethacrylate bone cement in percutaneous vertebroplasty: viscosity associated with cement leakage. Spine. 2010;35(20):1037–44.CrossRefGoogle Scholar
  19. 19.
    Bohner M, Gasser B, Baroud G, Heini P. Theoretical and experimental model to describe the injection of a polymethylmethacrylate cement into a porous structure. Biomaterials. 2003;24:2721–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Groen RJM, du Toit DF, Phillips FM, et al. Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system. Spine. 2004;29:1465–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg. 2002;96:56–61.PubMedGoogle Scholar
  22. 22.
    Heini PF, Berlemann U, Kaufmann M, Lippuner K, Fankhauser C, van Landuyt P. Augmentation of mechanical properties in osteoporotic vertebral bones—a biomechanical investigation of vertebroplasty efficacy with different bone cements. Eur Spine J. 2001;10:164–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Al Assir I, Perez-Higueras A, Florensa J, Muñoz A, Cuesta E. Percutaneous vertebroplasty: a special syringe for cement injection. Am J Neuroradiol. 2000;21:159–61.Google Scholar
  24. 24.
    Phillips FM, Todd WF, Lieberman I, Campbell-Hupp M. An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine. 2002;27:2173–8.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2012

Authors and Affiliations

  • Markus Weisskopf
    • 1
    Email author
  • Oliver Miltner
    • 2
  • Uwe Maus
    • 3
  • Sascha Gravius
    • 4
  • Jörg Axel Karl Ohnsorge
    • 5
  1. 1.Department of Spine SurgeryDillingen Wertingen HospitalsWertingenGermany
  2. 2.Department for Comprehensive Orthopedics & TraumatologyBerlinGermany
  3. 3.Department of Orthopaedic SurgeryUniversity Medical CentreMainzGermany
  4. 4.Department of Orthopaedic and Trauma SurgeryUniversity Hospital BonnBonnGermany
  5. 5.Department of Orthopaedic SurgeryUniversity Hospital, RWTH AachenAachenGermany

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