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Cavitational kyphoplasty: a new technique for reducing the rates of cement extravasation through targeted low-pressure cement injection

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Abstract

Background

Previous studies have demonstrated lower rates of cement extravasation when comparing balloon kyphoplasty with vertebroplasty, an effect attributed to the low-pressure injection. However, in patients with isolated endplate fractures, balloon kyphoplasty may lead to further endplate damage and increased risks of intradiscal extravasation.

Methods

The author provides a stepwise description of a new technique called cavitational kyphoplasty that allows targeted low-pressure cement injection without the necessity of balloon inflation.

Conclusions

The new technique of cavitational kyphoplasty has been shown to be specially useful in patients with isolated endplate fractures without significant loss of the vertebral body height.

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References

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Author information

Correspondence to Tobias A. Mattei.

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Electronic supplementary material

Clinical vignette of a 73-year-old male patient with a known history of osteoporosis and a history of a ground-level fall 4 weeks before the initial neurosurgical evaluation. The patient reported refractory axial mechanical pain at the thoracolumbar transition (8 out of 10 in the visual analogue scale) leading to a significant impairment of his quality of life. The MRI of the thoracic spine demonstrated a superior endplate fracture of T12 with significant bone marrow edema adjacent to the endplate as revealed by the hipointensity in the T1 and the hypertensintiy in the T2 sequence. The patient was initially prescribed 4 weeks of conservative treatment with reduction in the level of physical activities, oral analgesics and a TLSO brace. As he failed the conservative treatment, he was ultimatelly submitted to a T12 cavitational kyphoplasty performed through a left side approach. The patient presented a significant reduction in the level of the axial mechanical pain immediately after waking up from the procedure and was discharged home on the same day without the further necessity of a brace. (MP4 42,291 kb)

Video 1

Clinical vignette of a 73-year-old male patient with a known history of osteoporosis and a history of a ground-level fall 4 weeks before the initial neurosurgical evaluation. The patient reported refractory axial mechanical pain at the thoracolumbar transition (8 out of 10 in the visual analogue scale) leading to a significant impairment of his quality of life. The MRI of the thoracic spine demonstrated a superior endplate fracture of T12 with significant bone marrow edema adjacent to the endplate as revealed by the hipointensity in the T1 and the hypertensintiy in the T2 sequence. The patient was initially prescribed 4 weeks of conservative treatment with reduction in the level of physical activities, oral analgesics and a TLSO brace. As he failed the conservative treatment, he was ultimatelly submitted to a T12 cavitational kyphoplasty performed through a left side approach. The patient presented a significant reduction in the level of the axial mechanical pain immediately after waking up from the procedure and was discharged home on the same day without the further necessity of a brace. (MP4 42,291 kb)

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Mattei, T.A. Cavitational kyphoplasty: a new technique for reducing the rates of cement extravasation through targeted low-pressure cement injection. Acta Neurochir 159, 1153–1157 (2017). https://doi.org/10.1007/s00701-017-3167-3

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Keywords

  • Osteoporotic vertebral fractures
  • Vertebroplasty
  • Kyphoplasty
  • Endplate fractures
  • Compression fractures
  • Cement augmentation
  • Cement extravasation