Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

European Spine Journal - Tập 18 - Trang 1226-1233 - 2009
L. Grossterlinden1, P. G. C. Begemann2, W. Lehmann1, J. Nuechtern1, U. Schumacher3, H. D. Nagel4, W. Linhart5, G. Adam2, J. M. Rueger1, D. Briem1
1Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
3Institute of Anatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
4Philips Medizin Systeme GmbH, Hamburg, Germany
5Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Düsseldorf, Germany

Tóm tắt

Sacral insufficiency fractures can cause severe, debilitating pain to patients concerned. The incidence of this fracture type correlates with the appearance of osteoporosis in the elderly population. A polymethylmethacrylate (PMMA) cement injection procedure called sacroplasty has been recently described as an optional method for the treatment of this fracture type. However, the correct cement placement in the complex anatomical structure of the sacrum is a surgical challenge. The aim of the study is to compare the precision, safety, and radiation exposure of standard multiplanar fluoroscopy and computed tomography (CT) guidance for PMMA application to the sacrum using both balloon-assisted sacroplasty and conventional sacroplasty. A controlled experimental investigation in a human cadaver trial has been performed. Two imaging and two application modalities to monitor percutaneous PMMA injection to the sacrum were examined. The application forms were randomized from side to side of the pelvis. We found less cement extravasation in the CT-guided groups, but also a significant higher radiation exposure (P < 0.05) by using CT guidance. The conventional fluoroscopy-guided sacroplasty revealed the shortest procedure time (incision to closure time) of all treatment groups (P < 0.01). These findings show no difference regarding cement extravasation between ballon-assisted and conventional sacroplasty. Further, in comparison to fluoroscopy-assisted technique, the CT-guided cement injection seems to decrease the risk of cement extravasation, irrespective of the use of an additional balloon assistance. However, we have to consider a greater radiation exposure using CT guidance. Further investigations will proof the suitability in the normal course of clinical life.

Tài liệu tham khảo

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