Cement-directing kyphoplasty system yields positive results in long-term clinical testing

Issue: June 2012

Posterior leakage into the basivertebral vein or spinal canal can be minimized through control and direction of cement flow during balloon kyphoplasty, according to the authors of this study.

Perspective from Scott D. Boden, MD

The researchers worked with a cohort of 20 patients at least 50 years of age, all demonstrating up to three osteoporotic vertebral compression fractures located between T4 and L5, according to the study abstract. A curved drill and reamer were used to create a central cavity, which was used to unipedicularly perform a cement-directing kyphoplasty procedure on 37 levels overall.

Verbal pain scales and the Roland-Morris Questionnaire were used to determine pain relief and disability, respectively, with cement leakage being assessed within 24 hours postoperatively through anterior/posterior and lateral radiographs.

According to the abstract, the researchers reported immediate, significant postoperative pain relief that was sustained through a 2-year follow-up period. At the 6-week postoperative mark, disability scores improved. There was one report of a moderate cortical leak, as well as eight additional minor segmental vein and cortical leaks — none of which were symptomatic.

“Directed cement flow allows cement to fill the anterior vertebral body, stabilizing fractures and supporting biomechanical loading,” the authors wrote.

Perspective

Scott D. Boden, MD

Cement injection for acutely fractured vertebrae clearly has a role in the menu of treatment options for vertebral fractures. The two main challenges are determining the optimal trigger point to initiate this treatment to avoid over-treating fractures that will heal on their own and minimizing the side effects of treatment, namely emboli and extravasations. In theory, directionally controlled cement injection may minimize side effects, but it is likely that a much larger study in multiple operators’ hands would be needed to make that determination definitively. This study certainly warrants further investigation for the technique.

Scott D. Boden, MD

Director

Emory Orthopaedics & Spine Center

Atlanta, GA

Disclosures: Boden has no relevant financial disclosures.

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Sources/Disclosures

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Source:

Zarate B. J Spinal Disord Tech. 2012. doi: 10.1097/BSD.0b013e31824a7e2c