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Sacroplasty using a side hole injection device 2008

Interventional Spine

Bassem A Georgy, MD,

Scientific Paper

Purpose

Routine Sacroplasty can be associated with leakage of cement into the sacral neural foramina. The purpose of this study is to evaluate the safety and clinical feasibility of performing Sacroplasty using a bone filler device with a side hole to direct the cement away from such vital structures.

Methods & Materials

Retrospective evaluation of CT examination performed immediately after successful 14 sacroplasty procedures in 11 patients (9 women and 2 men) were reviewed after appropriate institutional approval. Eight cases were due to benign insufficiency fractures and 3 cases due to malignant metastasis. Nine cases were done under fluoroscopy guidance while 2 cases were performed using CT guidance.
All cases were performed using a kyphX directional bone filler device (Kyphon Inc, Sunnyvale, CA) with a single terminal side hole. An average 2 cc of bone cement was injected in each side. Cement was injected with the side hole directed towards the desired directions for cement deposition, usually away from the neural foramina. Pain relief was evaluated using visual analog scale before and within 2-4 weeks after the procedure during follow up.

Results

Cement was deposited along or nearby the fracture line in all cases. No cement leakage was noted in the sacral neural foramina. Two cases showed minimal cement in the nearby SI joint and were not significant. In one malignant case minimal leakage along the anterior wall of S2 was noted. Eight patients reported pain relief, while two patients had no pain relief. One patient was lost in follow up.

Conclusion

Injection devices with side-hole rather than end-hole may provide more directional control of the cement during injection. This technique may be used to redirect the cement away from critical structures and can be particularly useful in performing sacroplasty under fluoroscopy guidance.

References

Consultatnt, Kyphon Inc, Medtronic, Arthrocare, Advanced Bionics