EFFECT OF MECHANICAL ASPIRATION OF THE VERTEBRAL BODY ON PULMONARY ARTERIAL

PRESSURE BEFORE CEMENT INJECTION IN VERTEBROPLASTY PROCEDURE

Emine OKLU, MD

Cagatay OZTURK, MD

Selhan KARADERELER, MD

Levent ULUSOY, MD

Ahmet ALANAY, MD

Azmi HAMZAOGLU, MD

Istanbul Spine Center

Florence Nightingale Hospital

Istanbul-TURKEY

INTRODUCTION

The main complication during vertebroplasty is

leakage of cement and bone marrow content into the

adjacent structure and pulmonary circulation.

There has been concern about the increase in

intraosseous pressure and the displacement of bone

marrow contents leading to fat embolisms and

hypotension during the cement injection in VP.

To compare the efficacy of mechanical aspiration

technique just prior to cement application in standard

vertebroplasty procedure.

Forty patients having multilevel vertebroplasty (more

than 3 levels) due to osteoporotic vertebral compression

fractures were included in the study.

PURPOSE

PATIENT SAMPLE

MATERIALS & METHODS

All the procedures were done under local plus

sedation anesthesia.

Pulmonary arterial pressures were measured by

standart echocardiography and blood d-dimer values

were recorded preoperatively, 24 hours and 3 days

after the procedure.

MATERIALS & METHODS

In 20 patients (group A)

mechanical aspiration of the cavity was done with a flexible

aspiration tube just prior to cement application

In the remaining 20 patients (group B)

standard vertebroplasty procedure was done with the same

size cannula at the same injection force, injection speed and

cement viscosity.

MATERIALS & METHODS

The amount of injected cement was 3 ml for thoracic

levels and 4 ml for lumbar levels.

The effect of injecting bone cement was statistically

examined using a paired Student’s t test for the arterial

pressure and d-dimer data, comparing the minimum

value against the baseline value.

RESULTS

The mean age was 71 in group A and 70 in group B.

The average number of augmented levels was 6.7 in group A and

6.9 in group B.

Cement leakage occured in 4 patients in group A and 6 patients in

group B.

Acute hypotension during the cement injection occured in one

patient in group A and 4 patients in group B.

RESULTS The preoperative mean PAP was 35 mm/Hg in group A

48 mm/Hg on first postoperative day 42 mm/Hg on third postoperative day.

The preoperative mean PAP was 36 mm/Hg in group B 71 mm/Hg on first postoperative day 58 mm/Hg on third postoperative day (p<0.05).

The average blood D-dimer values in group A increased from 1.94 to 2.31 and in group B increased from 2.14 to 5.72 (p<0.05)

asymptomatic

CONCLUSION

Aspiration of the vertebral body just before cement

application decreases the injection forces and this in

turn decreases the risk of cement leakage and

migration of fatty particles to pulmonary circulation.

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