| Objective To observe the changes of the intraosseous pressure during percutaneous kyphoplasty, to investigate the clinical significance.Methods In vivo vertebral pressure measurements were performed on consecutive 27 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures. The mean age of the patients at the time of surgery was 67.96 years. There were 18 patients in the group of fresh fractures in which the treated fractures were less than 3 weeks. The other group was the obsolete fractures in which those fractures were older than 3 weeks, there were 9 patients. The intraosseous pressure was studied in the fractured vertebral body and next normal vertebrae. Under fluoroscopic control, one cannulated screw was placed into the posterior 4th of the vertebral body by a transpedicular route and connected to a pressure transducer, the other was placed percutaneously into the anterior third of the vertebral body through the contralateral transpedicular basilar part route and served as the injection route in the fractured vertebrae. Static pressure was measured and recorded. The changes of IOP of the traumaed vertebrae was observed during intraoperative. It was imperative that observed the peak pressure and the bone cement leakage. Maximum pressure elevation was calculated as peak pressure minus initial static pressure. The decreasing pressure of operative effect was calculated as initial static pressure minus the minimal pressure which measured at least 10 minutes post-injection. Patient surveys were used to assess pain relief on the 3rd day post-procedure.Results All surgeries were completed successfully. The static intraosseous pressure from 8～36mmHg,and the averaged (±sd)static intraosseous pressure was (18.24±15.84)mmHg in the intact vertebrae, and the peak pressure was 14～60 mmHg, the averaged pressure was (31.33±19.75)mmHg. The pressure of post-procedure and the averaged pressure was (7～30) mmHg and (15.67±11.15)mmHg respectively. But in the fractured vertebrae, it was 10～51mmHg and (31.19±22.23) mmHg respectively. The peak pressure and the pressure of post-procedure was 19～123mmHg and 5～46mmHg, and the averaged intraosseous pressure was (57.81±48.95) mmHg and (21.93±20.48)mmHg respectively. Statistically significant differences were found between intact vertebrae and fractured ones(P<0.05). Most of vertebrae in which the pressure measurement system remained patent (i.e., not occluded by bone marrow). Patient surveyed revealed the pain scores dropped from (9.48±1.31) to (2.57±2.20), significant pain reduction on the third day after surgery. The correlation coefficient was -0.26 and it demonstrated between the initial static pressure of the fractured vertebrae and the VAS of preoperative there was partial correlation. And between the decreasing pressure of operative effect and the decreasing VAS of postoperative, the correlation coefficient was -0.045.Both of them there was no linear regression. The group of fresh fractures in which the decreasing pressure was higher than 10mmHg the decreasing VAS was (6.33±4.08), but the other group the decreasing pressure was less than 10mmHg and the decreasing VAS was (7.17±0.80). There was no significant difference between them (P>0.05). The group of the obsolete fractures in which the decreasing pressure was higher than 10mmHg the decreasing VAS was (5.75±4.04), and other group the decreasing pressure was less than 10mmHg and the decreasing VAS was (7.25±0.98). There was also no significant difference between them (P>0.05). The bone cement leakage was found in 8 vertebrae, the initial static pressure was (28.63±27.56)mmHg, the maximum pressure elevation was (18.38±32.48) mmHg, and the decreasing pressure of postoperative was (7±10.58)mmHg. The other 23 vertebrae weren't found the bone cement leakage, the static pressure, the maximum pressure elevation and the decreasing pressure of postoperative was (32.09±20.49)mmHg, and (29.48±52.89)mmHg, and (10.04±14.69)mmHg respectively. There were not statistically significant differences were found between the two groups(P>0.05). Conclusion The IOP of fractured vertebral body significantly higher intraosseous pressures than the intact vertebrae. We did, find a partial correlation between back pain and relatively higher increased pressure in traumaed vertebral body. The other partial correlation was found between the decreasing pressure of operative effect and the decreasing VAS of postoperative. But we didn't find there was no correlation between the IOP elevation and the bone cement leakage during intraoperative.
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