Abstract No. 33 C Arm Cone Beam CT Needl (1)
Abstract No. 33
PURPOSE: To report our early clinical experience using
C-arm Cone Beam Computed Tomography (C-arm CBCT)
with fluoroscopic overlay for needle guidance during vertebroplasty.
MATERIALS & METHODS: Between November 2007 and
March 2008, eight consecutive patients underwent vertebroplasty of ten vertebral levels. Target and needle entry points
were selected on a C-arm CBCT image to determine a path
for the needle. The needle path, target point, and 3D image
are inherently registered to live fluoroscopy during the
procedure and used to guide needle placement. The target
point for each procedure was chosen to be at the midline of
the anterior 1/3 of the vertebral body. We retrospectively
reviewed the medical records and pertinent imaging studies.
Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral)
and complications were recorded. Success with the overlay
technology was assessed based on accuracy which was
defined as distance from planned path to final needle tip
within 5 mm and distance from midline to final needle tip
within 5 mm on multiplanar CBCT or fluoroscopy.
RESULTS: Imaging data for 9 vertebral levels was available
for review. Technical success for needle accuracy was
achieved in all levels (100%) with a mean of 3.38mm from
final needle tip position to planned path and a mean of 1.4
mm from final needle tip position to midline. The involved
levels included 5 lumbar and 5 thoracic levels. All vertebrae
were treated using unilateral access with all lumbar levels
accessed via a transpedicular route and all thoracic levels
via an extrapedicular approach. There was one case of
cement extravasation into the disc space.
CONCLUSION: Target path overlay for needle guidance
during fluoroscopy guided vertebroplasty is feasible and
allows for reliable unilateral therapy of both lumbar and
thoracic vertebral bodies.
4:24 PM
Abstract No. 34
Comparison of Intravertebral Pressure and Height Restoration in Three Minimally Invasive Treatments of
Vertebral Compression Fractures.
K. Murphy1, E. Wong2, R. Poser2, A. Kohm2; 1Univeristy
of Toronto, Toronto, ON, Canada; 2DFine Inc, San Mateo,
CA.
PURPOSE: To compare the intravertebral pressure (IP) and
height restoration during 3 vertebral compression fracture
(VCF) treatments.
MATERIALS & METHODS: 12 vertebral bodies (VBs)
from 7 osteoporotic human spines were utilized. The mean
age of donors was 77.3⫾5.9 years. VBs were loaded with an
offset load to induce a vertebral wedge fracture of 30%
anterior height reduction. 4 VBs were treated with one of
three different treatments; vertebroplasty (Vertebroplastic,
Depuy), balloon assisted kyphoplasty (BAK) (Medtronic),
vertebral augmentation system (VAS) (StabiliT, DFine). A
RESULTS: The mean anterior height restoration percentage
for the VAS, BAK and vertebroplasty was 51.9⫾27.2,
43.0⫾16.2 and 22.2⫾15.1 respectively. A paired t-test
yielded no significant differences between the VAS and
BAK (p⫽0.36) groups. Significant differences in anterior
height restoration did exist between VAS and vertebroplasty
(p⬍0.001) as well as BAK and vertebroplasty (p⫽0.003).
The mean max pressure during treatment for the VAS, BAK
and vertebroplasty was 9.8 ⫾ 0.1, 9.8 ⫾ 0.0, and 14.7 ⫾
9.7kPa. Wilcoxon signed rank tests did not yield any significant differences between the vertebroplasty and VAS
(p⫽0.5), vertebroplasty and BAK (p⫽1.0) or BAK and
VAS (p⫽1.0).
CONCLUSION: No significant differences in IP were observed for the 3 VCF treatments evaluated. Slightly higher
and wider ranges of IP were observed during vertebroplasty
as compared to those during VAS and BAK. Mechanical
VCF height elevation equivalent to that observed in BAK
was achieved using VAS, an innovative ultra-high viscosity
cement vertebral augmentation system. In contrast, conventional vertebroplasty procedure, in which cement simply
fills existing VCF voids prior to extravasation via the path
of least resistance, was unable to restore comparable height.
These data demonstrate the use of an ultra-high viscosity
cement and an appropriate delivery system can provide an
alternative to currently available methods to restore height
in a VCF without adverse increases in intravertebral pressure.
4:36 PM
Abstract No. 35
Initial Clinical Experience with Radio-Frequency Based
Vertebral Augmentation in Treatment of Vertebral
Compression Fractures.
L. Miko1, I. Szikora2, J. Grohs3, K. Murphy4; 1University
of Debrecen, Debrecen, Hungary; 2National Institute of
Neurosurgery, Budapest, Hungary; 3University Klinik Hospital, Vienna, Austria; 4Univeristy of Toronto, Toronto, ON,
Canada.
PURPOSE: Report initial clinical experience with novel
vertebral augmentation system with radiofrequency warming of PMMA cement for treatment of vertebral compression fractures.
MATERIALS & METHODS: StabiliT Vertebral Augmentation System (DFine Inc), a radio-frequency based cement
delivery system was used to treat vertebral compression
fractures. The system uses a proprietary PMMA cement
with extended working time prior to RF warming ultra-high
viscosity cement delivery on demand. 104 vertebral compression fractures were treated in 73 patients at three institutions by interventional neuroradiologists, orthopedic surgeons and neurosurgeons. Clinical evaluation were
performed pre and 1 day, 1 month and 3 months postoperative by Visual Analogue Scale (VAS) for pain and
Oswestry Disability Index (ODI) for function. Primary outcomes were pain and function. Secondary outcomes were
adverse events.
RESULTS: Mean VAS scores were preop - 7.5, 24 hours 2.4, 1 month - 3.4, 3 month - 3.1. Mean ODI scores (in %)
were preop - 55, 1 month - 39 and 3 month - 29. No adverse
events, extraforaminal or epidural leakage were observed.
S15
SUNDAY
C-Arm Cone Beam CT Needle Path Overlay for Fluoroscopic Guided Vertebroplasty.
A. Tam1, A. Mohamed2, M. Pfister3, E. Rohm3, A. Hall4,
M. Wallace4; 1University of Texas M.D. Anderson Cancer
Center, Houston, TX; 2Siemens Corporate Research, Inc.,
Princeton, NJ; 3Siemens AG, Healthcare Sector, AX Division, Forchheim, Germany; 4Siemens AG, Healthcare Sector, AX Division, Hoffman Estates, IL.
total of 6cc bone cement was injected per specimen. During
each procedure, IP was measured.
Scientific Sessions
4:12 PM
PURPOSE: To report our early clinical experience using
C-arm Cone Beam Computed Tomography (C-arm CBCT)
with fluoroscopic overlay for needle guidance during vertebroplasty.
MATERIALS & METHODS: Between November 2007 and
March 2008, eight consecutive patients underwent vertebroplasty of ten vertebral levels. Target and needle entry points
were selected on a C-arm CBCT image to determine a path
for the needle. The needle path, target point, and 3D image
are inherently registered to live fluoroscopy during the
procedure and used to guide needle placement. The target
point for each procedure was chosen to be at the midline of
the anterior 1/3 of the vertebral body. We retrospectively
reviewed the medical records and pertinent imaging studies.
Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral)
and complications were recorded. Success with the overlay
technology was assessed based on accuracy which was
defined as distance from planned path to final needle tip
within 5 mm and distance from midline to final needle tip
within 5 mm on multiplanar CBCT or fluoroscopy.
RESULTS: Imaging data for 9 vertebral levels was available
for review. Technical success for needle accuracy was
achieved in all levels (100%) with a mean of 3.38mm from
final needle tip position to planned path and a mean of 1.4
mm from final needle tip position to midline. The involved
levels included 5 lumbar and 5 thoracic levels. All vertebrae
were treated using unilateral access with all lumbar levels
accessed via a transpedicular route and all thoracic levels
via an extrapedicular approach. There was one case of
cement extravasation into the disc space.
CONCLUSION: Target path overlay for needle guidance
during fluoroscopy guided vertebroplasty is feasible and
allows for reliable unilateral therapy of both lumbar and
thoracic vertebral bodies.
4:24 PM
Abstract No. 34
Comparison of Intravertebral Pressure and Height Restoration in Three Minimally Invasive Treatments of
Vertebral Compression Fractures.
K. Murphy1, E. Wong2, R. Poser2, A. Kohm2; 1Univeristy
of Toronto, Toronto, ON, Canada; 2DFine Inc, San Mateo,
CA.
PURPOSE: To compare the intravertebral pressure (IP) and
height restoration during 3 vertebral compression fracture
(VCF) treatments.
MATERIALS & METHODS: 12 vertebral bodies (VBs)
from 7 osteoporotic human spines were utilized. The mean
age of donors was 77.3⫾5.9 years. VBs were loaded with an
offset load to induce a vertebral wedge fracture of 30%
anterior height reduction. 4 VBs were treated with one of
three different treatments; vertebroplasty (Vertebroplastic,
Depuy), balloon assisted kyphoplasty (BAK) (Medtronic),
vertebral augmentation system (VAS) (StabiliT, DFine). A
RESULTS: The mean anterior height restoration percentage
for the VAS, BAK and vertebroplasty was 51.9⫾27.2,
43.0⫾16.2 and 22.2⫾15.1 respectively. A paired t-test
yielded no significant differences between the VAS and
BAK (p⫽0.36) groups. Significant differences in anterior
height restoration did exist between VAS and vertebroplasty
(p⬍0.001) as well as BAK and vertebroplasty (p⫽0.003).
The mean max pressure during treatment for the VAS, BAK
and vertebroplasty was 9.8 ⫾ 0.1, 9.8 ⫾ 0.0, and 14.7 ⫾
9.7kPa. Wilcoxon signed rank tests did not yield any significant differences between the vertebroplasty and VAS
(p⫽0.5), vertebroplasty and BAK (p⫽1.0) or BAK and
VAS (p⫽1.0).
CONCLUSION: No significant differences in IP were observed for the 3 VCF treatments evaluated. Slightly higher
and wider ranges of IP were observed during vertebroplasty
as compared to those during VAS and BAK. Mechanical
VCF height elevation equivalent to that observed in BAK
was achieved using VAS, an innovative ultra-high viscosity
cement vertebral augmentation system. In contrast, conventional vertebroplasty procedure, in which cement simply
fills existing VCF voids prior to extravasation via the path
of least resistance, was unable to restore comparable height.
These data demonstrate the use of an ultra-high viscosity
cement and an appropriate delivery system can provide an
alternative to currently available methods to restore height
in a VCF without adverse increases in intravertebral pressure.
4:36 PM
Abstract No. 35
Initial Clinical Experience with Radio-Frequency Based
Vertebral Augmentation in Treatment of Vertebral
Compression Fractures.
L. Miko1, I. Szikora2, J. Grohs3, K. Murphy4; 1University
of Debrecen, Debrecen, Hungary; 2National Institute of
Neurosurgery, Budapest, Hungary; 3University Klinik Hospital, Vienna, Austria; 4Univeristy of Toronto, Toronto, ON,
Canada.
PURPOSE: Report initial clinical experience with novel
vertebral augmentation system with radiofrequency warming of PMMA cement for treatment of vertebral compression fractures.
MATERIALS & METHODS: StabiliT Vertebral Augmentation System (DFine Inc), a radio-frequency based cement
delivery system was used to treat vertebral compression
fractures. The system uses a proprietary PMMA cement
with extended working time prior to RF warming ultra-high
viscosity cement delivery on demand. 104 vertebral compression fractures were treated in 73 patients at three institutions by interventional neuroradiologists, orthopedic surgeons and neurosurgeons. Clinical evaluation were
performed pre and 1 day, 1 month and 3 months postoperative by Visual Analogue Scale (VAS) for pain and
Oswestry Disability Index (ODI) for function. Primary outcomes were pain and function. Secondary outcomes were
adverse events.
RESULTS: Mean VAS scores were preop - 7.5, 24 hours 2.4, 1 month - 3.4, 3 month - 3.1. Mean ODI scores (in %)
were preop - 55, 1 month - 39 and 3 month - 29. No adverse
events, extraforaminal or epidural leakage were observed.
S15
SUNDAY
C-Arm Cone Beam CT Needle Path Overlay for Fluoroscopic Guided Vertebroplasty.
A. Tam1, A. Mohamed2, M. Pfister3, E. Rohm3, A. Hall4,
M. Wallace4; 1University of Texas M.D. Anderson Cancer
Center, Houston, TX; 2Siemens Corporate Research, Inc.,
Princeton, NJ; 3Siemens AG, Healthcare Sector, AX Division, Forchheim, Germany; 4Siemens AG, Healthcare Sector, AX Division, Hoffman Estates, IL.
total of 6cc bone cement was injected per specimen. During
each procedure, IP was measured.
Scientific Sessions
4:12 PM