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Value Of High Viscosity Cement In Augmentation Of Advanced Malignant Compression Fractures 2013

Category Interventional Jennifer Padwal, BS
Mark Georgy
Bassem Georgy, MD
Purpose Vertebral augmentation in malignant compression fractures is associated with higher complication rates compared to benign fractures [i]. High viscosity cement is associated with lower leakage rate (1, 2). We are investigating the value of high viscosity cement in vertebroplasty performed in cases of advanced malignant compression fracture. Materials & Methods Institutional board approval was obtained for this retrospective study. 26 patients (17 females and 9 females with average age of 73.9) underwent vertebroplasty for pain control due to underlying different metastatic diseases were evaluated. A total of 37 levels treated. Post procedure CT and radiographs were evaluated for presence and location of leakage. Results All treated levels had epidural tumor extension or cortical bone disruption or both (8 levels) in pre procedure CT or MR studies. On post-procedure CT images, there were 25 cement leakages (67%), 15 venous, 8 discal, 3 epidural, and 1 leak in a neural foramen. 2 levels show 2 different leaks. Post procedure radiographs show 16 leakages (43%), 7 venous and 9 discal. None of those leaks were of any clinical significance and required any further intervention. Conclusion Vertebral augmentation using high viscosity cement in advanced malignant vertebral compression fracture is relatively safe. Although, there is a high cement leakage in post procedures CT, still less than published data in benign lesions (3). All leakage reported are minimal and does not appear to have any clinical consequences. References 1- Wong W, Mathis JM.  Vertebroplasty and Kyphoplasty: techniques for avoiding complications and pitfalls.  Neurosurg Focus.  18(3),1-10 2005 2- Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 2006;31:2562– 68 3- Venmans A., Klazen C.A.H.  , Lohle P.N.M.,  van Rooij W.J., Verhaar H.J.J. , de Vries J. and Mali W.P.Th.M.Percutaneous Vertebroplasty and Pulmonary Cement Embolism: Results from VERTOS II. AJNR 2010 Sept; 3:1451-1453