Abstract

Purpose
Higher viscous cement can be injected through larger-diametered tubes with lower pressure. The lower the cement modulus is, the less the stress-transfer would be. The lower-pressure percutaneous vertebroplasty with blood-mixed cement(LP-PVP^blood ) was devised to overcome technical problems in conventional percutaneous vertebroplasty(C-PVP). We would like to prove the validity of technical modifications to increase viscosity of cement being injected and reduce final modulus of cement.
Methods
Nineteen C-PVPs, 51 kyphoplasty (KPs), 23 LP-PVPs and 70 LP-PVP^blood s were analyzed in radiologic point of view. The successful cases with sufficient cement volume(≥ 5ml) were also analyzed as a subgroup.
Results
Asymptomatic cement leakage(CL) showed a similar tendency in LP-PV^blood (17.1%) compared to other groups(21.1~27.5%, p=0.514), even though the injected cement volume in LP-PVP^blood (6.9ml) was much more than that of C-PVP(3.5ml, p=0.000). Vertebral height restoration(VHR) was significantly higher(11.7%) than C-PVP(4.7%, p=0.024). Vertebral body subsidence(VS) was less in KP(1.1%) than others(2.1~5.9%, p=0.000). But, adjacent vertebral compression fractures(VCFs) happened more frequently in KP(15.7%) than others (0~5.3%, p=0.001). In subgroup analysis, the rates of successful cases were significantly higher in LP-PVP^blood (85.7%) than in C-PVP(5.3%, p=0.000). CLs and VHRs showed no significant differences. VS was significantly less in KP(1.0%, p=0.000) but adjacent VCF developed more frequently in KP(21.1%) than LP-PVP^blood (0%, p=0.001).
Conclusions
The LP-PVP^blood which stands for larger diameter tubes for injecting sufficient volume of higher viscous cement and more interdigitation by omitting balloon and lower modulus blood-mixed cement was appraised to reduce risk of cement leakage than C-PVP and decrease stress transfer to adjacent vertebrae than KP.

• Keywords: Lower-pressure blood mixed percutaneous vertebroplasty, Cement-related complications