Vertebral Body Lavage Reduces Hemodynamic Response to Vertebral Body Augmentation With PMMA

Abstract

Study design: Retrospective comparative study.

Objectives: To assess the effect of vertebral body lavage (VBL) on (1) systemic blood pressure, (2) heart rate, and (3) oxygen saturation following cement augmentation procedures for acute vertebral compression fractures (VCFs).

Methods: A total of 145 consecutive patients undergoing cement augmentation for acute VCF (mean age 74 ± 12 years, age range 42-96 years; 70% female; 475 levels treated) were allocated to the "lavage group" (n = 61 patients; VBL prior to cement application) and to the "control group" (n = 84 patients, no VBL). Mean arterial blood pressure (MAP), heart rate, and oxygen saturation were monitored immediately prior and 3 minutes after cement injection. Logistic regression analysis was performed with ΔMAP ≥10 mm Hg before and after cement injection as the dependent outcome variable and demographic, radiographic, and procedural factors as independent variables.

Results: MAP decreased by mean 3 ± 7.3 mm Hg before and after cement injection in the "lavage group" and 9 ± 10.5 mmHg in the control group (P < .001). There were no significant differences in terms of heart rate and oxygen saturation before and after cement application within each group, or between the 2 groups. Multivariate logistic regression analyses revealed VBL as an independent factor influencing MAP (adjusted odds ratio: 3.49 [confidence interval, 1.16-10.50], P = .03).

Conclusion: VBL prior to cement augmentation procedures reduces the hemodynamic response, most likely resulting from decreased amounts of bone marrow substance displaced into the circulation thereby decreasing the risk of pulmonary fat embolism syndrome.

Keywords: fat embolism syndrome; kyphoplasty; osteoporotic vertebral compression fracture; vertebral body lavage; vertebroplasty.

Figure 1.

Schematic illustration of the setup of vertebral body lavage is shown. Two Jamishidi cannulas are placed into the vertebral body (bipedicular access) to flush the vertebral body with 30 mL of saline solution. For this purpose, one syringe filled with 10 mL saline solution is attached to one cannula (left), whereas a second empty syringe is attached to the contralateral cannula (right). Vacuum is applied on the empty syringe thereby rinsing the vertebral body with saline solution and removing bone marrow particles from the vertebral body. This procedure is repeated three times. Positive pressure on the syringe filled with saline solution has to be avoided to not mimic the effect of direct cement injection and to prevent displacement of bone marrow and fat into the circulation.