Temperature gradient cement injection technique in percutaneous vertebroplasty for osteoporotic vertebral compression fractures

English Keywords:Kyphoplasty  Temperature gradient injection technique  Cement leakage

English Abstract:

  【Abstract】 Objectives: To explore the clinical efficacy and complications of temperature gradient cement injection technique in percutaneous vertebroplasty(PKP) for osteoporotic vertebral fractures(OVCF), by comparing with traditional single time cement injection technique. Methods: A total of 234 patients with OVCF from January 2010 to January 2006 were reviewed. The patients were divided into temperature gradient cement injection group (slow, low pressure, staged cement injection with 1-2 min intervals) and the traditional cement injection group (one time cement injection). Temperature gradient cement injection group included 129 patients with 160 vertebral fractures. Traditional injection group included 105 patients with 128 vertebral fractures. Outcomes were evaluated pre- and postoperatively by using visual analogue score(VAS), Oswestry dability index（ODI）, the local kyphosis angle, the anterior relative vertebral height ratio and the occurrence of cement leakage. Results: The average follow-up was 25.3±12.2 months in temperature gradient cement injection group, 24.7±11.5 months in the traditional cement injection group, and there was no significant difference between two groups(P＞0.05). The temperature gradient cement injection group: VAS score, ODI, local vertebral kyphosis angle and the relative anterior vertebral height ratio was 7.19±0.94, 71.55±7.83, 16.66°±8.40°, (62.50±24.64)％ respectively before surgery, 2.18±0.62, 28.86±4.71, 11.72°±7.81°, (84.50±14.92)％ respectively after surgery, and 2.1±1.9, 28.79±6.25, 11.87°±8.34°, (85.49±12.67)％ respectively at the final follow-up. The traditional injection group: VAS score, ODI, local vertebral kyphosis angle and anterior relative height ratio was 7.20±1.07, 70.49±9.28, 16.97°±9.48°, (61.91±24.84)％ respectively before surgery, 2.25±0.64, 28.55±4.46, 11.90°±7.42°, (85.09±10.71)% respectively after surgery, and 2.3±2.5, 28.51±6.55, 11.92°±9.03°, (85.10±14.61)％ respectively at the final follow-up. The VAS score, ODI, local vertebral kyphosis angle and the relative anterior vertebral height ratio were significantly improved after operation in both groups(P<0.05). There was no significant difference of the outcomes between postoperation and final follow-up(P>0.05). There was no significant difference between two groups preoperatively, postoperatively and at the final follow-up(P＞0.05). Cement leakage occured in only 3 patients(2.3%) in temperature gradient cement injection group, which was significantly less than traditional cement injection group(8 patients, 8.6%)(P<0.05). Conclusions: Satisfactory imaging and clinical results can be obtained by the method of temperature gradient cement injection technique. Also, it can reduce the incidence of bone cement leakage.