EFFECT OF CEMENTING ON PULMONARY ARTERIAL PRESSURE IN

VERTEBROPLASTY (VP): A COMPARISON OF TWO TECHNIQUES

Emine Öklü, MD* Cagatay Ozturk, MD*

Mehmet Aydogan, MD* Sinan Karaca, MD*

Selhan Karadereler, 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 structures 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 cement injection in VP.

THE AIM OF THE STUDY

The aim of the study was to compare the effect of low and high viscosity cements on pulmonary arterial pressure during

vertebroplasty.

MATERIAL AND METHODS

Forty-two patients were treated with more than 3 levels of VP.

Group A had 22 patients. They were treated with a high viscosity cement by 4 mm cannulas.

Group B had 20 patients. They were treated with a low viscosity cement by 8 mm cannulas.

The amount of injected cement was 3 ml for thoracic and 4 ml for lumbar levels.

MATERIAL AND METHODS

Pulmonary arterial pressures(PAP) were measured by standard echocardiography: preoperatively and postoperatively 1st and 3rd days.

Blood d-dimer values were recorded: preoperatively and on postoperative day 3rd.

Collected PAP and d-dimer data were compared between the two groups. The minimum value and the baseline value were assessed.

RESULTSThe mean age was 69 in group A and 70 in group B.

The sex, diagnosis, and presence of comorbidities were similar in both groups.

The average number of augmented levels was 5.4 in group A and 5.7 in group B (p>0.05).

Cement leakage occured in 3 patients in group A and 4 patients in group B.

Acute hypotension during the cement injection occured in one patient in group A and 3 patients in group B.

Changing of the Pulmonary Arterial Pressure (mm/Hg)

(p<0.05)

D-dimer values

(p<0.05)

S.D. 80Y. F; T6,T7 Acute, T11 healed frc.

T5 – T10 PERCUTANEUS VERTEBROPLASTY

M.A.I. 67Y. M; T5 & T9 FRC.

T4 – T10 PERCUTANEUS VERTEBROPLASTY

CONCLUSION

Injecting high viscosity cement thorugh a narrower cannula produced significantly lower PAP and d-dimer level increase than injecting low viscosity cement through a wider cannula.

However, the cement leakage rate was similar in both techniques.

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