EFFECT OF MECHANICAL ASPIRATION OF THE VERTEBRAL BODY ON PULMONARY ARTERIAL PRESSURE BEFORE CEMENT INJECTION IN VERTEBROPLASTY PROCEDURE Emine OKLU, MD Cagatay OZTURK, MD Selhan KARADERELER, MD Levent ULUSOY, MD Ahmet ALANAY, MD Azmi HAMZAOGLU, MD Istanbul Spine Center Florence Nightingale Hospital Istanbul-TURKEY

INTRODUCTION The main complication during vertebroplasty is leakage of cement and bone marrow content into the adjacent structure and pulmonary circulation. There has been concern about the increase in intraosseous pressure and the displacement of bone marrow contents leading to fat embolisms and hypotension during the cement injection in VP.

To compare the efficacy of mechanical aspiration technique just prior to cement application in standard vertebroplasty procedure. Forty patients having multilevel vertebroplasty (more than 3 levels) due to osteoporotic vertebral compression fractures were included in the study. PURPOSE PATIENT SAMPLE

MATERIALS & METHODS All the procedures were done under local plus sedation anesthesia. Pulmonary arterial pressures were measured by standart echocardiography and blood d-dimer values were recorded preoperatively, 24 hours and 3 days after the procedure.

MATERIALS & METHODS In 20 patients (group A) mechanical aspiration of the cavity was done with a flexible aspiration tube just prior to cement application In the remaining 20 patients (group B) standard vertebroplasty procedure was done with the same size cannula at the same injection force, injection speed and cement viscosity.

MATERIALS & METHODS The amount of injected cement was 3 ml for thoracic levels and 4 ml for lumbar levels. The effect of injecting bone cement was statistically examined using a paired Student’s t test for the arterial pressure and d-dimer data, comparing the minimum value against the baseline value.

RESULTS The mean age was 71 in group A and 70 in group B. The average number of augmented levels was 6.7 in group A and 6.9 in group B. Cement leakage occured in 4 patients in group A and 6 patients in group B. Acute hypotension during the cement injection occured in one patient in group A and 4 patients in group B.

RESULTS The preoperative mean PAP was 35 mm/Hg in group A 48 mm/Hg on first postoperative day 42 mm/Hg on third postoperative day. The preoperative mean PAP was 36 mm/Hg in group B 71 mm/Hg on first postoperative day 58 mm/Hg on third postoperative day (p<0.05). The average blood D-dimer values in group A increased from 1.94 to 2.31 and in group B increased from 2.14 to 5.72 (p<0.05)

asymptomatic

CONCLUSION  Aspiration of the vertebral body just before cement application decreases the injection forces and this in turn decreases the risk of cement leakage and migration of fatty particles to pulmonary circulation.

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