Kyphos and Veins

[manowar rules]

---

Members do not see this ad.

What do you guys do during a kypho where you see some venous extravasation of cement? I had one today where I thought I saw a line extending anterior, at that point I had only put in about 1cc. This lady was in bad pain and I didn’t want to abort quite yet. I withdrew a bit, waited a minute, and re-injected, but looked like some still went to vein. I ended up quickly accessing contralateral and put a couple more squirts in that thankfully stayed put before calling it quits. Curious what others do

 

[lobelsteve]

Do exactly what you did. Stop injecting ASAP. Wait 60-100 seconds while spinning the needle in place to prevent it getting locked in. Called eggshelling. Then pull back 4-5mm and try injecting again.

 

[RoloTomassi]

With curved kit you can pull back then redirect. Would still wait a while but less pressure than scrambling to get the other side in

 

[Orin]

Do exactly what you did. Stop injecting ASAP. Wait 60-100 seconds while spinning the needle in place to prevent it getting locked in. Called eggshelling. Then pull back 4-5mm and try injecting again.

Stop injection and make sure it's really a leak as sometimes a bowel loop or other artifact tricks you.

You can pull back, re-access, etc , but I normally try to first give it some time to solidify in the body and then rechallenge with cement. With balloon kypho, I try to back into the middle of the cavity with the injector.

Eggshelling to me normally involves reinflating the balloon within a cement bolus to create a shell of cement around the balloon. I do that in some lytic lesions but it's time consuming.

There are perhaps better cements that are more likely to be reliably solid but marrow is unfortunately vascular. I'm not sure studies on volume show a clear correlation between cement amount and pain relief 🤔

 

[DesertDoc16]

We purposefully ruptured the Balloon in a cadaver at an advanced Kypho course…. Illustrates the extensive vascularity of the VB

 

[RoloTomassi]

We purposefully ruptured the Balloon in a cadaver at an advanced Kypho course…. Illustrates the extensive vascularity of the VBView attachment 360366

Very interesting. How many psi?

 

[DesertDoc16]

Very interesting. How many psi?

It was was one of their high pressure balloons, but it blew at 400psi (supposed to go to 700)…. They said the cadavers were still frozen and can have ice crystals that rupture the balloons.