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Vesselplasty: A New Technical Approach to Treat Symptomatic Vertebral Compression Fractures

¹ Department of Radiology, Hospital Universitario Doctor Peset, Avd. Gaspar Aguilar 90, Valencia 46017, Spain.
² Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
³ Department of Radiology, Maimonides Medical Center, Brooklyn, NY.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Photograph shows Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). From right to left: stylet, cannula tube, precision drill, and Vessel-X bone filling container; Vessel-X introducer and pushing rod are inside bone filling container. Controllable cement delivery device is on top.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Photographs show vesselplasty procedure using Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). (Courtesy of A-Spine Holding Group Corporation) Bone access needle is introduced through pedicle, retaining it 2-3 mm anterior to posterior wall of vertebra body.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Photographs show vesselplasty procedure using Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). (Courtesy of A-Spine Holding Group Corporation) Precision drill is introduced through cannula tube until tip of drill is positioned 2-3 mm posterior to anterior wall of vertebra.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Photographs show vesselplasty procedure using Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). (Courtesy of A-Spine Holding Group Corporation) Precision drill is removed, and Vessel-X bone filling container (balloon catheter) is inserted into cannula tube.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Photographs show vesselplasty procedure using Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). (Courtesy of A-Spine Holding Group Corporation) Controlled cement extrusion.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —Photographs show vesselplasty procedure using Vessel-X Bone Filling Container System (A-Spine Holding Group Corporation). (Courtesy of A-Spine Holding Group Corporation) Process is repeated through contralateral pedicle.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —43-year-old woman with traumatic vertebral compression fracture. Coronal (A) and sagittal (B) images obtained after 180° C-arm rotation show vesselplasty being performed transpedicularly with left unilateral approach.

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —43-year-old woman with traumatic vertebral compression fracture. Coronal (A) and sagittal (B) images obtained after 180° C-arm rotation show vesselplasty being performed transpedicularly with left unilateral approach.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Photograph shows bone cement being injected into vertebral body of patient with vertebral compression fracture. Precision drill has been removed and is being held in operator's left hand. Cement delivery system is connected to Vessel-X Bone Filler Container (A-Spine Holding Group Corporation).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Bar graph shows distribution of vertebral compression fractures by treatment level.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Treatment outcomes for 29 patients in study cohort. Box plots compare pain (A), mobility (B), and analgesic use (C) scores before and after vesselplasty. Whiskers indicate smallest and largest non-outlier observations; thin black lines, lower and upper quartiles; thick black line, median; and circle in B, outlier value in patient 27.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Treatment outcomes for 29 patients in study cohort. Box plots compare pain (A), mobility (B), and analgesic use (C) scores before and after vesselplasty. Whiskers indicate smallest and largest non-outlier observations; thin black lines, lower and upper quartiles; thick black line, median; and circle in B, outlier value in patient 27.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Treatment outcomes for 29 patients in study cohort. Box plots compare pain (A), mobility (B), and analgesic use (C) scores before and after vesselplasty. Whiskers indicate smallest and largest non-outlier observations; thin black lines, lower and upper quartiles; thick black line, median; and circle in B, outlier value in patient 27.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Lateral radiograph of lumbar spine shows L4 vertebral compression fracture.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Schematic drawing of preoperative measurements of anterior (A), medial (M), and posterior (P) vertebral body heights.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Vesselplasty was performed using right transpedicular approach (C) and left transpedicular approach (D).

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Vesselplasty was performed using right transpedicular approach (C) and left transpedicular approach (D).

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7E —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Lateral radiograph shows final result.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7F —55-year-old man with corticoid-induced osteoporosis and lower back pain. Vesselplasty with transpedicular and bilateral approach was performed. Schematic drawing of postoperative measurements of anterior (A), medial (M), and posterior (P) vertebral body heights. Increments of 2 mm in A, 3 mm in M, and 5 mm in P were observed.

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