Abstract No. 34: Comparison of Intravertebral Pressure and Height Restoration in Three Minimally Invasive Treatments of Vertebral Compression Fractures

Article Outline

• Purpose
• Materials & Methods
• Results
• Conclusion
• Copyright

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Purpose 

To compare the intravertebral pressure (IP) and height restoration during 3 vertebral compression fracture (VCF) treatments.

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Materials & Methods 

12 vertebral bodies (VBs) from 7 osteoporotic human spines were utilized. The mean age of donors was 77.3±5.9 years. VBs were loaded with an offset load to induce a vertebral wedge fracture of 30% anterior height reduction. 4 VBs were treated with one of three different treatments; vertebroplasty (Vertebroplastic, Depuy), balloon assisted kyphoplasty (BAK) (Medtronic), vertebral augmentation system (VAS) (StabiliT, DFine). A total of 6cc bone cement was injected per specimen. During each procedure, IP was measured.

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Results 

The mean anterior height restoration percentage for the VAS, BAK and vertebroplasty was 51.9±27.2, 43.0±16.2 and 22.2±15.1 respectively. A paired t-test yielded no significant differences between the VAS and BAK (p=0.36) groups. Significant differences in anterior height restoration did exist between VAS and vertebroplasty (p<0.001) as well as BAK and vertebroplasty (p=0.003). The mean max pressure during treatment for the VAS, BAK and vertebroplasty was 9.8 ± 0.1, 9.8 ± 0.0, and 14.7 ± 9.7kPa. Wilcoxon signed rank tests did not yield any significant differences between the vertebroplasty and VAS (p=0.5), vertebroplasty and BAK (p=1.0) or BAK and VAS (p=1.0).

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Conclusion 

No significant differences in IP were observed for the 3 VCF treatments evaluated. Slightly higher and wider ranges of IP were observed during vertebroplasty as compared to those during VAS and BAK. Mechanical VCF height elevation equivalent to that observed in BAK was achieved using VAS, an innovative ultra-high viscosity cement vertebral augmentation system. In contrast, conventional vertebroplasty procedure, in which cement simply fills existing VCF voids prior to extravasation via the path of least resistance, was unable to restore comparable height. These data demonstrate the use of an ultra-high viscosity cement and an appropriate delivery system can provide an alternative to currently available methods to restore height in a VCF without adverse increases in intravertebral pressure.