Bassem A Georgy, MD North County Radiology Assistant Professor of Radiology

1. Percutaneous vertebroplasty for osteoporotic and malignant fractures: Experience with high viscosity cement using a hydrolic injection device, the “CONFIDENCE” system Bassem A Georgy, MD North County Radiology Assistant Professor of Radiology University of San Diego, California

2. Background • Precise control of cement delivery is necessary to minimize the risk of cement leakage • Cavity creation had been linked to decreased leakage without scientific evidence • Higher-viscosity cements associated with lower leakage rates in laboratory vertebral compression model • Higher rate of leakage had been reported with malignant lesions

4. 5 min 8 min 11 min

5. Purpuse • To assess the clinical feasibility of performing Vertebroplasty on osteoporotic and malignant compression fractures using an ultra viscous cement injected by a hydrolic device to further control cement deposition.

6. Material and Methods • Single center retrospective review of post-operative radiographs of 125 patients and 213 levels • 94 with benign osteoporotic fractures • 31 patients with malignant compression fractures lesions • All patients treated with Confidence system. • C7 to L5 vertebral bodies.

7. Material and Methods • The degree of leakage was assessed at each treated level using a strict 4-point scale (none, minimal, moderate, severe). • The pattern of any observed leakage was also characterized as: discal, venous, paravetebral, or epidural. • VAS values were available in 25 patients(14 malignant and 11 benign)

8. Mild venous leakage Moderate Disk leakage Severe Disc leakage

9. Results Benign Lesions • Pre-operatively the mean degree of vertebral collapse was 29% • There was no leakage in 50%, • Minimal leakage in 42%, • Moderate leakage in 7% of cases • One case of severe leakage

10. Results Malignant Lesions • Pre-operatively the mean degree of vertebral collapse was 27% • There was no leakage in 50%, • Minimal leakage in 40%, • Moderate leakage in 10% of cases • No case of severe leakage

11. Results • The most frequent pattern of leak was venous seen in 52% of leaks, the adjacent disc in 46%, and para- vertebral in 5 % • There were no symptomatic leaks that required surgical intervention. • Leakage rates were very similar in both benign and malignant lesions • Average 51% decrease in pain using VAS scores

12. 84 Woman, Osteoporotic Fractures

13. 66 y woman, osteoporotic fracture

14. T9 L4 T12

15. T9 T12 L4

16. T9 T9 T12 T12 L4 L4 Post-op

17. 42 year-old-women with breast cancer

18. 65 yea-old-women with breast metastasis T7, L1, L4 lesions

19. 75 year-old woman with Myeloma T3 lesion

21. 67 year-old-man with Myeloma and T1 lesion

23. 60 years old women with Breast cancer

26. C7 C7 C7 Lung Cancer

27. CT guided anterior approach using 15G, 4”, needle

29. Conclusion • Vertebroplasty in both osteoporotic and malignant vertebral fractures using a highly viscous cement that can be safely controlled and injected via a hydrolic system can be performed safely with out significant complications