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Preventing Cement Leaks During Vertebroplasty

Posted on: 05/11/2006
Bone fractures are common in the aging population. Anyone with osteoporosis or bone tumors is especially at risk. Vertebral (spine) fractures are painful and lead to deformity and reduced quality of life. Injecting cement into the fractured spine called vertebroplasty is one treatment option.

One of the main problems with vertebroplasty is leakage of the cement injected into the bone. Side effects of leakage are uncommon but if the cement leaks, then the bone isn't repaired. Doctors are looking for ways to prevent leakage.

They've tried partially curing the cement before injecting it. This step increases the thickness of the cement and slows down how fast it moves. They have limited how much cement is used to avoid overfilling and overflow. Low-pressure injections with small syringes have been tried. Pulling the needle out slowly to avoid back flow has been used as well.

The use of gelfoam to block venous channels is the focus of this study. Gelfoam is a liquid form of gelatin. It's made from sponge cut into tiny pieces. When injected into the bone before the cement, the gelfoam temporarily blocks the veins. This type of blockage is called embolization. It prevents cement from getting through.

Once the gelfoam is in place, then the cement can be injected. X-rays and CT scans were used after the surgery to assess the results. Leakage still occurred in about 25 percent of the patients. Leakage occurred more often in cases of malignancy compared to osteoporosis.

The authors conclude routine use of gelfoam embolization is safe when used before vertebroplasty. It's more likely to be effective when vertebral fractures are caused by highly vascular tumors. Preinjecting gelfoam to prevent cement leakage may give more patients the treatment option of vertebroplasty.

Chandra Bhatia, Mch, Orth, et al. Cement Leakage in Percutaneous Vertebroplasty. In Spine. April 15, 2006. Vol. 31. No. 8. Pp. 915-919.

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