Investigation on Cement Leakage on Vertebroplasty and Reconstruction for Spinal Compression Fracture
试验速览
- 阶段
- 不适用
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- prevalence of pulmonary embolism
研究概览
简要总结
Vertebral compression fracture is a common disorder in elderly patients. Vertebroplasty or surgical fixation are therefore commonly performed, in which bone cement is injected and help to provide additional support for unstable fracture to ease the pain. Cement leakage to paraspinal vein is very common and often taken as indicator of endpoint of the procedure. However, the leaked cement entering venous system can go to right heart and cause pulmonary embolism sometimes. The prevalence and pattern of this problem is largely unknown, especially subclinical condition. In this project, we intend to perform in vivo investigation of the cement distribution under different injection conditions. We also plan to conduct a clinical study to investigate the pattern, prevalence, and risk factor of cement venous leakage and pulmonary embolism. The study is a prospective cohort design, in which we plan to recruit 60 patients who receive vertebroplasty or cemented pedicle screws fixation for vertebral compression fracture. Plain X ray and computed tomography (CT) will be performed after operation. For CT, plain CT for operated site and dual energy acquisition for pulmonary vasculature will be performed, in which the pulmonary perfusion will be detected precisely. The different modalities can help delineate of radiological pattern of cement leakage. Spine surgeon, interventional radiologist, neuroradiologist, and thoracic radiologist will participate in this project. Experience on the optimal technique for cement use under fluoroscope is expected. The knowledge obtained in this study can be used in clinical ground and translate into academic outcome and clinical patient care.
详细描述
Background Vertebral compression fracture is a common disease. Most of them are osteoporotic and minority of them are pathological. It cause severe pain and compression to neuronal tissue, leading to debilitating symptom and deficits. The quality of life can be reduced; long-term bed ridden can also cause morbidity and mortality. It is thus a major public health issue. Vertebroplasty and related procedure is an invasive procedure to restore vertebral stability by injection bone cement, usually under minimal percutaneous approach. Because of its immediate efficacy of pain relief, it is very popular and common procedure.
However, the cement is liquid before it become solid in the vertebrae. It can spread into venous system sometime, and even going into pulmonary circulation system. The latter cause pulmonary thromboembolism. Operators usually try their best to avoid such complication. Practically, severe complication is rare. According to prior literature, the cement leakage range from 2.1 to 26%. It indicate the problem is actually common. On the other hand, the cement can not be lysed by usual anticoagulant treatment. Detection of this condition can be of clinical importance.
Currently, the clinical epidemiology of cement leakage after vertebroplasty is not well studied. Many factors can contribute its occurrence, including technical, material, and patient-specific reasons. Although operators have their approach to avoid such conditions, there are little evidence to support the efficacy of individual preventive method. Actually, some operator tolerate minor paraspinal leakage because they believe it can achieve optimal cement filling in the vertebrae. However, it is unclear the relationship between paraspinal leakage and pulmonary embolism.
In detection of pulmonary thromboembolism, imaging method is mainstream. Currently, dual energy CT scan can provide optimal diagnosis of leaked cement and pulmonary perfusion status. The iodine map derived from material decomposition provide an easy way to detect perfusion defect. It can be used to detect and classify cement pulmonary embolism.
In this study, we aim to evaluate the clinical epidemiology of cement leakage in vertebroplasty and related surgery, focusing on the prevalence, severity, and risk factors. Based on the reference dual energy CT, we also want to investigate its imaging characteristics.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •vertebral compression fracture requiring vertebroplasty or cemented transpedicular screws fixation
- •older than 20 year old
排除标准
- •active infection
- •progressive neurological deterioration,
- •coagulopathy
- •renal insufficiency (serum creatinine > 1.5 mg/dL
- •severe allergic reaction to contrast medium
- •pregnant or breast-feeding women
结局指标
主要结局
prevalence of pulmonary embolism
时间窗: 6 months
detection of cement pulmonary embolism on contrast enhanced dual energy CT
次要结局
- prevalence of paraspinal venous leakage(6 months)