Procedure of the Month

You chose: Vertebral Body Augmentation. - CORRECT

Vertebral body augmentation, especially with high viscosity cements such as those provided by the CONFIDENCE SPINAL CEMENT SYSTEM™, represent a surgical option for this patient.

Candidates for this procedure are patients that do not heal within 4-6 weeks post-injury and suffer significant pain, unresponsive to conservative care.

A recent study also showed that patients with extensive bone marrow edema (>50% of the entire vertebrae), as observed for this case on preoperative MRIs, were particularly responsive to the injection of a vertebral body cement that would immobilize the fracture site (2).

Multiple types of cements are available for this type of procedure. A recent in-vitro preclinical study showed that high viscosity cements result in more uniform filling of the vertebral body with lower rates of leakage, as compared to low-viscosity cements (3). The cement in the CONFIDENCE SPINAL CEMENT SYSTEM™ is a high-viscosity cement.

 

 

A new high-viscosity Vertebral Body Augmentation System.

The CONFIDENCE SPINAL CEMENT SYSTEM™ is a novel vertebral body augmentation system, designed to provide controlled delivery of a highly viscous cement with an extended working time.

The cement in the CONFIDENCE SPINAL CEMENT SYSTEM is dispensed into the vertebral body using a hydraulically actuated delivery system (Figure 3) that allows accurate placement of the cement in the fractured area.

Figure 3: Hydraulically-actuated delivery system for accurate and controlled delivery of high-viscosity cement in the vertebral body. The delivery system is provided sterile and ready to use.

Figure 4: The long built-in delivery tube allows physicians to remain out of the fluoroscopy field during the entire procedure.

The cement adopts a dough-like consistency immediately after mixing, and does not require any wait time prior to implantation. This cement has an 9.5-minute working time and is radio-opaque (30.07% w/w BaSO4) for fluoroscopic monitoring.

Systems are available with 11-, 13- and 15-gauge diamond and 11- and 13-gauge beveled tip needles, as well as a new side hole needle design that provides a smooth and controlled delivery of the cement into the vertebral body.

 

Detailed Surgical Technique for This Patient.

The procedure was performed under conscious sedation. The patient’s heart rate, blood pressure and PO-2 were measured with electronic monitors throughout the procedure. The procedure was performed under strict antiseptic conditions and under intravenous coverage of antibiotic.

The patient was placed in the prone position. The L1 level was identified under fluoroscopy. The skin was then prepped and draped using standard antiseptic techniques. The periosteum was anesthetized using 1% lidocaine. A bipedicular approach was used to access the vertebral body, using 13-gauge needles (Figure 5 & 6 below).

Figure 5: Bipedicular approach. The shadows above the needles are the outlines of the delivery system.	Figure 6: A lateral view confirms the correct location of both needles through the pedicles.

The cement from the CONFIDENCE SPINAL CEMENT SYSTEM was then injected. Approximately 5cc of cement was introduced in the vertebral body, filling the fracture area. The cement created a spherical fill pattern as seen in Figures 7 and 8 below. Interdigitation of the cement was clearly observed with the surrounding bony trabeculae.

Figure 7: Lateral view of the L1 level after filling with the high-viscosity cement. No extravasion of the cement was observed.	Figure 8: A/P view confirming fill of the vertebral body, with no cement extravasion.

The patient tolerated the procedure well with no complications. Successful internal fixation of the L1 level using the bipedicular approach with the high-viscosity cement of the CONFIDENCE SPINAL CEMENT SYSTEM was achieved.

If you are interested in more information regarding the DePuy Spine
CONFIDENCE SPINAL CEMENT SYSTEM™ :

Visit us online at:
www.depuyspine.com
www.confidencespinalcement.com

CLICK HERE TO CONTACT US FOR MORE INFORMATION
ABOUT THE CONFIDENCE SPINAL CEMENT SYSTEM™

EMAIL US AT: DePuySpine@dpyus.jnj.com

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Reference List

1. Mehbod A, Aunoble S, Le Huec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. [Review] [64 refs]. European Spine Journal 2003;12:Suppl-62.
   
2. Tanigawa N, Komemushi A, Kariya S et al. Percutaneous vertebroplasty: relationship between vertebral body bone marrow edema pattern on MR images and initial clinical response. Radiology 2006;239:195-200.
   
3. Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 2006;31:2562-8.