The main reasons for the high pressure of bone cement injection are: 1. delayed bone cement injection time, which caused increased bone cement viscosity; 2. Blocking the tip of the cannula with bone cement or bone debris; 3. The cannula is bent. For these three reasons, attention should be paid during operation:1. Control the working time and status of bone cement; 2. When there is excessive pressure occurred, cannula can be slightly pulled out and change the injection points; 3. During the process of inserting the curved cannula or connecting the bone cement injector, it is mandatory to hold the puncture needle firmly to prevent it from shaking or changing its position.

Hicren PMMA bone cement is a bone cement specially for spine surgery, it has good operability and can be used in conjunction with curved vertebroplasty instruments.

Firstly, we need to make sure balloon in vacuum state. Picture as bellow:

Ensure the balloon in a vertical initial position with puncture needle interface to insert.

With balloon inserting, make sure it horizontally with puncture needle.

it's not slip during surgery with glove. If still hard, the medical silicone oil can be used or any medical oil.

In special circumstances, lateral decubitus position can also be used to complete the surgery.

When taking CT scanning, adjust the angles of the C-arm machine to ensure that the upper and lower endplates, spinous processes, and pedicle of the responsible vertebrae are clearly visible.

High viscosity bone cement requires the use of high-pressure injection devices for bone cement injection, and bone cement is not easily dispersed within the vertebral body. The advantage is that there is a low risk of leakage, while the disadvantage is that the bone cement forms clumps in the vertebral body, and stress concentration can easily lead to re-fracture of the vertebral body;

The dispersion effect of low viscosity bone cement is relatively good, with the advantage of good bone cement anchoring and sufficient filling, while the disadvantage is high leakage risk;

It is recommended to use HICREN spinal specific bone cement, paired with curved vertebroplasty instruments, to achieve better dispersion and three column mechanical stability. It helps to prevent or avoid the recurrence of fractures in the strengthened vertebral body, and has better long-term effects.

Generally speaking, the injection volume into the thoracic spine ranges from 3 to 4ml, and the lumbar spine does not exceed 6ml. Some scholars believe that injecting full bone cement is beneficial for filling the fracture gaps, and non fracture areas also need to have bone cement dispersion to have a good stable effect. To achieve better treatment results, it is necessary to have some support for the upper and lower endplates.

Osteoporosis

Insufficient cement filling of responsible vertebrae

Leakage of bone cement into intervertebral space

Postoperative anti-osteoporosis treatment needs to be standardized and bone density checked regularly. Standardized anti-osteoporosis treatment can reduce bone loss and vertebral height loss. Clinical statistics show that standardized anti-osteoporosis treatment greatly reduces the incidence of recurrent fractures.