Zusammenfassung
Vertebroplasty is an interventional radiology procedure used to treat vertebral compression fractures. It shows promising results but has two major drawbacks: the excessive injection pressure and the risk for extraosseus cement leakage. To examine each of these problems, vertebroplasty is divided into intra- and extravertebral components. The excessive injection pressure is an extravertebral problem because 95\% of the injection pressure is extravertebral. Extant solutions are cement delivery devices and lowering the cement viscosity. Additionally, the cannula can be redesigned to lower the friction and injection pressure. The extraosseus cement leakage is an intravertebral problem. Literature recommends delaying the injection to increase the control over the infiltration of cement; this hypothesis is tested using a synthetic model. The bone cement has complex rheological properties, which are modified by altering the cement preparation and composition; these may also play a role in controlling cement leakage. Combining the findings, conflicting demands on the cement viscosity are clearly demonstrated; the extravertebral component demands low-viscosity cement while the intravertebral component demands high-viscosity cement. The challenge is therefore to develop biomaterials, techniques and/or devices that can control the conflicting demands on cement viscosity.
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