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Initial Single Center Experience with Unipedicular Radiofrequency Vertebral Augmentation 2011

Interventional Spine

Bryan, A, Pukenas, MD
Gaurav, Jindal, MD, Non ASSR Member
Robert, W, Hurst, MD, Non ASSR Member

Poster

Purpose

Kyphoplasty and vertebroplasty for treatment of osteoporotic compression fractures is well described in the literature. Although there is controversy regarding efficacy of these procedures, studies show that when performed in a timely manner, patients usually experience significant pain relief,1and the use of high viscosity cement results in decreased complications due to cement leakage.2 A unipedicular approach decreases procedure time, operator radiation exposure, and cost.3 We describe our initial experience with the StabiliT (Dfine, San Jose, CA) vertebral augmentation system.

Methods & Materials

4 patients with acute (less than 6 weeks old) osteoporotic compression fractures were treated with the StabiliT ultra high viscosity radiofrequency (RF) vertebral augmentation system. Assessment of pain was performed using the visual analog scale (VAS) performed during the preprocedure office visit and via telephone at day 3. A unipedicular approach was used for all patients. In some cases, intra-procedural DynaCT was performed for further evaluation. Procedure time and procedural radiation exposure was not measured during this initial experience. In 3 patients one level was treated, one patient had 3 levels treated, for a total of 6 vertebral levels. In one patient, cement encroachment on the inferior endplate was noted. Due to the prolonged working time of the cement, the cement introducer cannula was removed from the patient for approximately 5 minutes, allowing the interbody cement to cure. Cement was again deployed after the cannula was repositioned in the vertebral body with an excellent result.

Results

Three patients experienced significant reduction in pain by day 3. Although patient 2 only experienced a 3 point reduction in the VAS, she inadvertently failed to continue on her oral pain medication regimen. There was one asymptomatic cement disc extravasation. Radiation exposure was not measured, but the manufacturer provided tubing allowed the operator to stand at least 6 feet from the X-ray source for all procedures.

Conclusion

Unipedicular RF vertebral augmentation using ultra high viscosity cement is technically feasible and safe. All patients had decreased VAS scores at 3 days. The asymptomatic disc extravastion was likely secondary to over-aggressive cement deployment and operator inexperience with the ultra high viscosity cement flow dynamics. The unipedicular approach may potentially reduce procedure time, and operator and patient radiation exposure.

References/Financial Disclosures

1. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. Sep 25 2010;376(9746):1085-1092. 2. Rapan S, Jovanovic S, Gulan G, Boschi V, Kolarevic V, Dapic T. Vertebroplasty--high viscosity cement versus low viscosity cement. Coll Antropol. Sep 2010;34(3):1063-1067. 3. Papadopoulos EC, Edobor-Osula F, Gardner MJ, Shindle MK, Lane JM. Unipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: early results. J Spinal Disord Tech. Dec 2008;21(8):589-59 No Financial Disclosures

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