1
|
Rare Episode of Cement Leakage During Vesselplasty in a Case of Vertebral Compression Fracture. World Neurosurg 2020; 137:416-420. [PMID: 32084615 DOI: 10.1016/j.wneu.2020.02.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. CASE DESCRIPTION A 77-year-old woman presented with debilitating back pain owing to acute T6 compression fracture as detected by magnetic resonance imaging. Under biplanar fluoroscopy, vesselplasty using a polyethylene terephthalate balloon container was performed at the T6 vertebrae. During cement injection, balloon rupture and cement leakage occurred compromising the spinal canal. Emergent laminectomy and cement removal were performed. Paraplegia developed postoperatively. CONCLUSIONS Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.
Collapse
|
2
|
Liu X, Wei D, Zhong J, Ma M, Zhou J, Peng X, Ye Y, Sun G, He D. Electrospun Nanofibrous P(DLLA-CL) Balloons as Calcium Phosphate Cement Filled Containers for Bone Repair: in Vitro and in Vivo Studies. ACS APPLIED MATERIALS & INTERFACES 2015; 7:18540-18552. [PMID: 26258872 DOI: 10.1021/acsami.5b04868] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The spinal surgeon community has expressed significant interest in applying calcium phosphate cement (CPC) for the treatment of vertebral compression fractures (VCFs) and minimizing its disadvantages, such as its water-induced collapsibility and poor mechanical properties, limiting its clinical use. In this work, novel biodegradable electrospun nanofibrous poly(d,l-lactic acid-ϵ-caprolactone) balloons (ENPBs) were prepared, and the separation, pressure, degradation, and new bone formation behaviors of the ENPBs when used as CPC-filled containers in vitro and in vivo were systematically analyzed and compared. CPC could be separated from surrounding bone tissues by ENPBs in vitro and in vivo. ENPB-CPCs (ENPBs serving as CPC-filled containers) exerted pressure on the surrounding bone microenvironment, which was enough to crush trabecular bone. Compared with the CPC implantation, ENPB-CPCs delayed the degradation of CPC (i.e., its water-induced collapsilibity). Finally, possible mechanisms behind the in vivo effects caused by ENPB-CPCs implanted into rabbit thighbones and pig vertebrae were proposed. This work suggests that ENPBs can be potentially applied as CPC-filled containers in vivo and provides an experimental basis for the clinical application of ENPBs for the treatment of VCFs. In addition, this work will be of benefit to the development of polymer-based medical implants in the future.
Collapse
Affiliation(s)
- Xunwei Liu
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Daixu Wei
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Jian Zhong
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Mengjia Ma
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
| | - Juan Zhou
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
| | - Xiangtao Peng
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Yong Ye
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital , No. 25 Shifan Road, Jinan 200050, Shandong Province, People's Republic of China
| | - Dannong He
- National Engineering Research Center for Nanotechnology , No. 28 East Jiangchuang Road, Minhang District, Shanghai 200241, People's Republic of China
- School of Materials Science and Engineering, Shanghai Jiao Tong University , No. 800 Dongchuang Road, Minhang District, Shanghai 200240, People's Republic of China
| |
Collapse
|