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KMID : 1148120130030020064
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Journal of Advanced Spine Surgery
2013 Volume.3 No. 2 p.64 ~ p.73
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Lower-pressure Percutaneous Vertebroplasty with Blood-mixed Cement: A Novel Device to avoid Cementrelated Complications
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Ahn Dong-Ki
Moon Sang-Ho
Choi Dae-Jung
Jung Woo-Sik
Shin Won-Shik
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Abstract
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Purpose: Higher viscous cement can be injected through larger-diametered tubes with lower pressure. The lower the cement modulus is, the less the stress-transfer would be. The lower-pressure percutaneous vertebroplasty with blood-mixed cement(LP-PVPblood) was devised to overcome technical problems in conventional percutaneous vertebroplasty(C-PVP). We would like to prove the validity of technical modifications to increase viscosity of cement being injected and reduce final modulus of cement.
Methods: Nineteen C-PVPs, 51 kyphoplasty (KPs), 23 LP-PVPs and 70 LP-PVPbloods were analyzed in radiologic point of view. The successful cases with sufficient cement volume(≥ 5ml) were also analyzed as a subgroup.
Results: Asymptomatic cement leakage(CL) showed a similar tendency in LP-PVPblood(17.1%) compared to other groups(21.1~27.5%, p=0.514), even though the injected cement volume in LP-PVPblood(6.9ml) was much more than that of C-PVP(3.5ml, p=0.000). Vertebral height restoration(VHR) was significantly higher(11.7%) than C-PVP(4.7%, p=0.024). Vertebral body subsidence(VS) was less in KP(1.1%) than others(2.1~5.9%, p=0.000). But, adjacent vertebral compression fractures(VCFs) happened more frequently in KP(15.7%) than others (0~5.3%, p=0.001). In subgroup analysis, the rates of successful cases were significantly higher in LP-PVPblood (85.7%) than in C-PVP(5.3%, p=0.000). CLs and VHRs showed no significant differences. VS was significantly less in KP(1.0%, p=0.000) but adjacent VCF developed more frequently in KP(21.1%) than LP-PVPblood(0%, p=0.001).
Conclusions: The LP-PVPblood which stands for larger diameter tubes for injecting sufficient volume of higher viscous cement and more interdigitation by omitting balloon and lower modulus blood-mixed cement was appraised to reduce risk of cement leakage than C-PVP and decrease stress transfer to adjacent vertebrae than KP.
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KEYWORD
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Lower-pressure blood mixed percutaneous vertebroplasty, Cement-related complications
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