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. 2020 Oct 26;16(2):200-206.
doi: 10.13004/kjnt.2020.16.e42. eCollection 2020 Oct.

Gelfoam Embolization Technique to Prevent Bone Cement Leakage during Percutaneous Vertebroplasty: Comparative Study of Gelfoam only vs. Gelfoam with Venography

Jae-Min Ahn  1 , Jae-Sang Oh  1
Affiliations

Gelfoam Embolization Technique to Prevent Bone Cement Leakage during Percutaneous Vertebroplasty: Comparative Study of Gelfoam only vs. Gelfoam with Venography

Jae-Min Ahn et al. Korean J Neurotrauma. .

Abstract

Objective: Percutaneous vertebroplasty (VP) has been used for the safe treatment of osteoporotic compression fracture. However, cement leakage is the most common complication. To reduce the leakage of bone cement, we did the gelfoam embolization during VP. The purpose of this study is to compare the safety and feasibility of different two gelfoam embolization technique during VP.

Methods: Total 127 patients (146 level) who had the thoracolumbar osteoporotic compression fracture were enrolled. Group A was treated by gelfoam-only technique and, Group B was treated by gelfoam with venography technique. We compared the incidence of bone cement leakage between two groups using post-operative computed tomography scan and X-ray.

Results: Seventy-four patients (81 levels) were treated with gelfoam-only technique (A), and 53 patients (65 levels) were treated with gelfoam with venography technique (B). There were 22 leakages on group A, and 19 leakages on group B. There was no statistical significant difference between two groups (Chi-square test, p-value =0.958). Incidence of leakage to spinal canal was 11 levels in Group A, 3 levels in group B, and there was statistical significant difference (Fisher's exact test, p-value=0.027).

Conclusion: Complication induced by the bone cement leakage are the most careful point during VP. Gelfoam embolization with venography is very easy and safe method. Gelfoam with venography technique could make lower the incidence of cement leakage to spinal canal.

Keywords: Compression fracture; Gelfoam; Osteoporosis; Venography; Vertebroplasty.

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Conflict of interest statement

Conflict of Interest: The authors have no financial conflicts of interest.

Figures

FIGURE 1
FIGURE 1. Preparation of Gelfoam with venography technique. (A) Gelfoam sponge was cut into 5×5 mm size. (B) Gelfoam pieces were mixed with 3 mL of normal saline and 7 mL of contrast material using 10-mL syringe.
FIGURE 2
FIGURE 2. (A) Venography before vertebroplasty showed leakage to the anterior vertebral body via fracture line (white arrow) and to the disc space (black arrow). (B) After advance of needle, no cement leakage was noted.
FIGURE 3
FIGURE 3. Cement leakage classification. (A) Leak into the paravertebral muscle and soft tissue, (B) leakage into the paravertebral vein, (C) leakage into the disc space, (D) leakage into the spinal canal.
See this image and copyright information in PMC

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