Cement leakage prevention in kyphoplasty by selectively applying bioceramic bone granules

Objective To selectively apply calcium phosphate cement to percutaneous kyphoplasty(PKP) to study its effect in preventing cement leakage.Methods From June 2009 to May 2011,a total of 116 patients with fresh vertebral fracture in which vertebral body anterior lateral wall was defected to different degrees by CT scan were randomly allocated into two groups.The control group was treated with normal PKP procedure and the experiment group with PKP in addition to bioceramic bone granules.We recorded the weight of bone granules,the volume of cement injection and leakage rate and outcome.We assessed pain severity(VAS scale) and the height compression rate of anterior vertebrae(Lee method),measured kyphosis angle(Cobb method) before and after surgery;CT scans were taken to observe the postoperative cement leakage.Results PKP was successfully performed in all the patients.Fifty-eight cases were chosen in the experiment group planted with bioceramic bone granules(2.83±1.67 g,bone cement volume of 3.74±0.66 mL).There were totally 5 cement extrusions,with a leakage rate of 3.4%.The average VAS improvement after operation was 6.14±0.95;anterior vertebral height compression rate was improved by 21.74±1.99%,and kyphotic angle was improved by 23.72±2.33.Postoperative CT scan showed that bone granules were filled well in the anterior of vertebrae.Another 58 cases were treated in the control group with bone cement volume of 4.01±0.61 mL.There were 8(13.8%) leakages out of 58.Analysis with SPSS 17.0 statistic software showed significant differences in bone cement planted and cement leakage rate between the two groups(P0.05).However,the two groups did not significantly differ in VAS scores,restoration rate of anterior vertebral height or kyphosis angle(P0.05). Conclusion Our findings suggest that bioceramic bone granules selectively applied to PKP not only is effective but also can reduce the volume of cement injection and decrease the incidence of cement leakage.