Vertebral augmentation has revolutionized the treatment of painful vertebral body compression fractures. Vertebroplasty and Kyphons kyphoplasty procedure (balloon assisted vertebroplasty) are both very effective at pain relief but additional studies are needed to determine if there are differences in height restoration. Many balloon assisted vertebroplasty practitioners feel that it is clinically advantageous to create a mechanical void within the vertebral body prior to instillation of PMMA. Some studies have shown reduced cement extravasation with balloon-assisted vertebroplasty. The purpose of this study is to evaluate the technical and clinical effectiveness of Parallax Contour (Arthrocare Spine). Contour is a curved nitinol mechanical osteotome that can be advanced and rotated to create a mechanical void in cancellous bone. The device is deployed through a 10.5 gauge threaded cannula.
Materials and Methods
Sixty patients (48 women, 12 men; mean age 77.2 years) underwent Contour-assisted vertebral augmentation (CAVA) on 75 vertebral bodies (47 lumbar and 28 thoracic) in 66 treatment sessions over a six-month period. Procedural data such as volume of cavity created, volume of PMMA injected, and presence of cement extravasation was recorded. Before the procedure and at follow-up, patients were asked to quantify their pain on a visual analog scale (VAS).
Results
CAVA was technically successful in all patients and there were no complications. The mean cavity volume was 1.55cc (0.33-2.02) and the mean volume of PMMA instillation was 5.89cc (2.9-11). There were 4 asymptomatic cement leaks into paravertebral veins (5.3%). Prior to CAVA the mean VAS score was 8.89+/-1.32. Follow-up was obtained in all patients with a mean follow-up period of 3.6 months (1-7) and the mean VAS score was 2.21+/-1.85. The mean difference in VAS score was statistically significant (P<.0001).
Conclusion
Contour-assisted vertebral augmentation was technically and clinically successful in treating symptomatic vertebral compression fractures. CAVA should be considered as an alternative to balloon-assisted vertebroplasty.
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