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Research article
Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution
Yanping Zheng
Shandong University Qilu Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3842-8013
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Journal of Orthopaedic Surgery and Research.
Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.
Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated.
Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group.
Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.
Keywords
percutaneous vertebroplasty, unilateral pulsed jet lavage, intravertebral pressure, cement distribution
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CURRENT STATUS: Published
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Posted 06 Jun, 2020
Published
On 11 Jul, 2020
No community comments so far
Editorial decision: Accept
On 29 Jun, 2020
Review #2 received
Received 17 Jun, 2020
Review #1 received
Received 14 Jun, 2020
Reviewer #2 agreed
On 06 Jun, 2020
Reviewers invited
Invitations sent on 03 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Editor assigned
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
No comments provided
Editorial decision: Major revision
On 06 May, 2020
Review #3 received
Received 01 May, 2020
Review #4 received
Received 30 Apr, 2020
Review #2 received
Received 22 Apr, 2020
Reviewer #4 agreed
On 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewer #3 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Reviewer #2 agreed
On 16 Apr, 2020
Reviewers invited
Invitations sent on 15 Apr, 2020
Editor assigned
On 14 Apr, 2020
Editor invited
On 13 Apr, 2020
Submission checks complete
On 08 Apr, 2020
First submitted
On 06 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
Orthopedic Surgery
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This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution
Yanping Zheng
Shandong University Qilu Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3842-8013
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 06 Jun, 2020
Published
On 11 Jul, 2020
No community comments so far
Editorial decision: Accept
On 29 Jun, 2020
Review #2 received
Received 17 Jun, 2020
Review #1 received
Received 14 Jun, 2020
Reviewer #2 agreed
On 06 Jun, 2020
Reviewers invited
Invitations sent on 03 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Editor assigned
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
No comments provided
Editorial decision: Major revision
On 06 May, 2020
Review #3 received
Received 01 May, 2020
Review #4 received
Received 30 Apr, 2020
Review #2 received
Received 22 Apr, 2020
Reviewer #4 agreed
On 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Reviewer #3 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Reviewer #2 agreed
On 16 Apr, 2020
Reviewers invited
Invitations sent on 15 Apr, 2020
Editor assigned
On 14 Apr, 2020
Editor invited
On 13 Apr, 2020
Submission checks complete
On 08 Apr, 2020
First submitted
On 06 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Journal of Orthopaedic Surgery and Research.
Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.
Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated.
Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group.
Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.
Figure 1
Figure 2
Figure 3
Figure 4