Article
Biplanar fluoroscopy increases safety of vertebroplasty – a prospective study
Die biplanare Fluoroskopie erhöht die Sicherheit des Verfahrens der Vertebroplastie – eine prospektive Studie
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Authors
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M. Klingenhöfer
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
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F. Rommel
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
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B. Turowski
- Abteilung für Neuroradiologie, Universitätsklinikum Düsseldorf
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H.-J. Steiger
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
| Published: | April 11, 2007 |
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Outline
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Objective: Typical complications of vertebroplasty are compression of spinal nerves or the spinal cord, infection and pulmonary embolism. The complication rate has been reported to be as high as 10% in cases with involvement of the posterior vertebral wall. Cement leakage without clinical sequelae is seen in up to 65%. We performed a prospective study to scrutinize the value of biplanar fluoroscopy during cement introduction to reduce the risk of cement leakage and complications.
Methods: In 80 consecutive patients vertebroplasty was performed in 104 levels using biplanar fluoroscopy. 19 levels were affected by metastasis, 9 by myelomas and 3 levels had vertebral haemangiomas. 73 levels had osteoporotic fractures. High contrast vertebroplasty cement (Osteopal V™) was injected using a screw-cylinder-type application system (Cemento™, Biomet). Cement flow was controlled using biplanar fluoroscopy. CT scans and conventional radiographs were performed within 24 hours after the procedure.
Results: In all cases reduction of pain and no neurological or pulmonary complications were observed. At 27 levels cement leakage was detected by biplanar fluroscopy during cement injection (25,9%). A filling of small paravertebral veins we seen in 12 cases (11,5%), paravertebral cement leakage was detected in 3 cases (2,9%) and intervertebral cement leakage in 8 cases (7,7%). We saw 29 cases with involvement of the posterior vertebral wall, but only 4 cases showed minimal cement leakage into the spinal canal (3,8%). Postinterventional CT scans showed identical cement leakage as perceived with biplanar fluroscopy during the procedure. No additional leakage was detected.
Conclusions: High-quality biplanar digital fluoroscopy reduces the occurrence of clinical and radiological complications in vertebroplasty. Postinterventional CT scans do not provide further information concerning cement leakage outside the vertebra. Together with patient surveillance under local anesthesia, i.e. an awake patient, vertebroplasty is a very safe treatment to reduce pain, even in high risk patients.
