Could Contour-assisted vertebral augmentation be an alternative to kyphoplasty?


A new study presented at the Society of Interventional Radiology’s 35th Annual Meeting concluded that Contour-assisted vertebral augmentation (CAVA) was technically and clinically successful in treating symptomatic vertebral compression fractures

J Kevin Mcgraw, Riverside Radiology and Interventional Associates, Columbus, USA, who presented the study said, “CAVA should be considered as an alternative to kyphoplasty.”

“Vertebral augmentation has revolutionised the treatment of painful vertebral body compression fractures. Both vertebroplasty and kyphoplasty  (balloon assisted vertebroplasty) are highly effective  for  pain relief, but additional studies are needed to determine if there are differences in height restoration,” he said.

Mcgraw told SIR delegates that many balloon assisted vertebroplasty practitioners feel that it is clinically advantageous to create a mechanical void within the vertebral body prior to instillation of bone cement. The purpose of the study was to evaluate the technical and clinical effectiveness of Parallax Contour (Arthrocare Spine). Contour is a curved nitinol mechanical osteotome that can be advanced and rotated to create a mechanical void in cancellous bone. The device is deployed through a cannula.

In the study 60 patients (48 women, 12 men; mean age 77.2 years) underwent Contour-assisted vertebral augmentation on 75 vertebral bodies (47 lumbar and 28 thoracic) in 66 treatment sessions over a six-month period. Procedural data such as volume of cavity created, volume of cement injected, and presence of cement extravasation was recorded. Before the procedure and at follow-up, patients were asked to quantify their pain on a visual analog scale (VAS).

Investigators found that CAVA was technically successful in all patients and there were no complications. They said the cement leak rate for CAVA was almost half the reported rate for balloon kyphoplasty. Four asymptomatic cement leaks into paravertebral veins (5.3%) were also reported. Prior to CAVA, the mean VAS score was 8.89+/–1.32. Follow-up was obtained in all patients with a mean follow-up period of 3.6 months (1–7) and the mean VAS score was 2.21+/–1.85. The mean difference in VAS score was statistically significant.