Double Cement-Application Cavity Containment Kyphoplasty: Technique Description and Efficacy

Kyphoplasty is an effective surgical treatment for the pain and deformity that can accompany vertebral compression fractures. In certain cases, however, defects or clefts in the vertebral body result either from the original fracture or from expansion of inflatable bone tamps (IBTs). Through such a defect, cement may extrude into the epidural space, paraspinal soft tissues, or disc space. In addition, by virtue of the dynamic nature of certain fracture configurations, the height restored by inflation of the bone tamps may be lost once the tamps are removed for cement placement, despite patient positioning.

In our modification of the kyphoplasty technique, we use 2 cement applications to minimize potential extravertebral cement extravasation and maintain the height restoration achieved with the IBTs. After 0.75 to 1.5 cm³ of cement is deposited, the IBTs are reinserted into the fracture and inflated until the cement cures. Once the cement is cured, the IBTs are again deflated and removed, leaving a cement shell that seals the cracks and supports the endplates. Then, another batch of cement is mixed and is used to fill the cavities, as in the standard technique.

Results for our first 21 patients show a mean correction of more than 6° of kyphosis and no cement leaks into the spinal canal. We believe that this modification of the kyphoplasty technique is effective and safe for certain fractures.