Clinical Application Of Improved Percutaneous Vertebroplasty

Clinical Application of Improved PercutaneousVertebroplasty[ Background ]Low back pain due to osteoporosis, myeloma, metastasis and vertebral angioma is a troublesome problem to clinical, often, it gives lot of medical cost but harvests little effect. Percutaneous vertebroplasty as a interventional radiology technology solve this problem more easy, multiple case studies have documented an approximately 80% success rate for pain relief. However, the leakage of cement is so high that perhaps lead to some serious complications, such as nerve root hurt, spinal compression, pulmonary embolism and so on. Though the incidence rate is low, it can still increase as the method spread all over the world and evoke peoples' attentions. Scholars are researching kinds of methods to cut down the leakage of cement, such as adding wolfram, tantalum powder to bone cement to improve the cement visualization, some using the high-quailty perspective equipment, but there is still a high leakage of cement.We analysis the reasons of the cement leaking and consider that change the state of injecting of bone cement is the most important point, it means to improving the injecting consistency and degrade injecting pressure. So we improve the PVP technology, a bone drill is used to expand the vertebral body to creative a space before inject cement, then the cement can be injected at a high consistency and low pressure state, thus can degrade the leakage and serious complications.As a result, there are two parts in this study. Part one, a retrospective study was conducted to review 29 PVP that have been practiced before. Part two, prospectively study 25 patients of improved PVP and assess and discussion the security, complication and effectiveness of this technology.Part one [Objective]To assess and discussion the leakage of bone cement and effectiveness of percutaneous vertebroplasty technology.[Methods]Forty-four treatment vertebral for twenty-nine patients (17 male and 12 female, age range 36-81yrs, mean age at treatment, 59.6)were accepted percutaneous vertebroplasty from December of 2005 to January of 2007.The causes of pain were osteoporosis vertebral body compression fracture(15 patients) and metastases (14 patients).Two groups were divided according to the cause of osteoporosis and metastases. Record the leakage of bone cement according the image of post-procedural. The visual analogue scale (VAS) was taken to objectify pre- and post-procedural changes in whole and groups. To evaluate the significance of the data obtained, the paired Student t- test and group t-test were used. A P value <.05 for both statistical tests would be considered significant.[Results]The procedure was successful in all patients, no complications related to the procedure were recorded. The cement amount were l-5ml, average range (2.47±0.29)ml, nine vertebral appear cement leakage, one was in the intervertebral discs, the others were in the basivertebral veins around, two were in the anterior internal vertebral veins, 1 was in the Infrapedicular vein, the others five were in the anterior external venous plexus, the rate of leakage was 20.5%(9/44), no nerve root hurt or spinal compression was observed except one pulmonary embolism. The whole VAS pre- and post-procedural were(7.3±0.5) and (1.8±0.4)(P<0.001), the VAS improved between osteoporosis group and metastases group were no significant(P>0.5).[ Conclusion ]According to the research, PVP is an effective treatment for low back pain due to osteoporosis vertebral body compression fracture, vertebral hemangioma or metastases in clinical work, but the cement leakage was higher, this maybe cause serious complication. Part two[Objective]To assess and discussion the security, complication and effectiveness of improved percutaneous vertebroplasty technology[Methods]Forty-one treatment vertebral for twenty-five patients (12 male and 13 female, age range 40-84yrs ,mean age at treatment,61.9yrs±5.1 [standard deviation])were accepted improved percutaneous vertebroplasty by transpedicular under DSA from April of 2007.The causes of pain were osteoporosis vertebral body compression fracture(14 patients) and metastases(l 1 patients).Two groups were divided according to the cause of osteoporosis and metastases. The amount of cement and cement leakage were recorded. The visual analogue scale (VAS) and Oswestry disability Index(ODI) were taken to objectify pre- and post-procedural changes in whole and groups. To evaluate the significance of the data obtained, the paired Student t- test and group Mest were used. A P value <.05 for both statistical tests would be considered significant.[Results]The procedure was successful in all patients, no complications related to the procedure were recorded. The cement amount were 3-6ml, average range (4.1±0.3)ml, two vertebral appear cement leakage, the rate of leakage was 4.9%(2/41),no nerve root hurt, spinal compression or pulmonary embolism occurred. The whole VAS pre- and post-procedural were(7.52±0.41) and (1.80±0.45)(P<0.001), ODI were (72.04±5.10)% and(16.98±4.10)% (P<0.001); the group of osteoporosis VAS pre- and post-procedural were (7.50±0.57) and(1.50±0.49)(P<0.001), ODI were (74.99±6.88)% and (14.92±0.05)% (P<0.001);the group of metastases VAS pre- and post-procedural were(7.27±0.60) and (2.18±0.78) (P<0.001),ODI were(68.29±7.22)% and(19.61±6.74)%(P<0.001);the osteoporosis group VAS and ODI improvement were super than metastases group, but no significant(P>0.5). Thirteen-three patients were followed up more than 3 months, The VAS pre- and post-procedural were(7.62±0.65) and (1.64±0.53)(P<0.001), ODI were (72.37±6.91)% and(13.00±4.34)%(P<0.001),the VAS and ODI between post-procedural and three months follow up were no difference(P>0.2和P>0.1).[Conclusion]According to the research, the procedure of improved PVP has been proved to be safe and effective in treating low back pain of due to osteoporosis vertebral body compression fracture and metastases in clinical work, also can reduce the occurrence of cement leakage and serious complication.