Cement leakage

Nakano M, Hirano N, Ishihara H, Kawaguchi Y, Matsuura K. Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures risk factor analysis for cement leakage. J Neurosurg Spine. 2005 Jan 2(1) 27-33. 

The injection of cement is observed under continuous lateral fluoroscopic or online CT-fluoroscopy control to allow for instant detection of leakage (Fig. 38.4). If a leakage is detected, it is very important to stop the procedure, reverse the pressure, and wait for up to 60 s. This time allows the cement to harden and probably seal the leak. If the leak then persists, the needle either has to be repositioned or the bevel direction should be modified. In cases in which these measures are not effective, the procedure should be abandoned. To complete the filling of the affected vertebral body, the contralateral approach could be used. In order the avoid cement leakage through the puncture canal, the initial needle should remain in place. 

It has been reported that cement leakage is more common when PV is used for metastatic osteolytic tumors or myelomas of the spine than in osteoporotic fractures. However, Vasconcelos et al. (2002) observed no major differences, although they noted venous leaks slightly more frequently in patients with metastatic lesions. When PV was performed in osteoporotic vertebral compression fractures, leakage into the disc space was more commonly observed. Mousavi et al. (2003) reviewed post-procedural GT scans in patients with osteoporotic vertebral compression fractures and metastatic lesions of the spine and concluded that in osteoporotic vertebrae leakage occurred mainly into the disc, whereas in metastatic lesions it was found in various different locations. 

Using current methods for PMMA injection, there is a high risk of cement leakage into the spinal canal when the cement is injected in the posterior region of the vertebral body. However, the above-mentioned biomechanical studies indicate that cement injection in this region tends to provide improved biomechanical stability to the vertebral body (Ahn et al. 2006). Cement leakage, particularly into the spinal canal, is still considered as the primary concern associated with PV However, as the effects of cement location and volume become better understood, less cement injection may be required... 

Chen, Y.J., Tan, T.S., Chen, W.H., et al. Intradural cement leakage a devastatingly rare complication of vertebroplasty. Spine 31, E379-E382 (2006)... 

Corcos, G., Dbjay, J., Mastier, C., et al. Cement leakage in percutaneous vertebroplasty for spinal metastases a retrospective evaluation of incidence and risk factors. Spine 39, E332-E338 (2014)... 

Fig. 12.68a,b. Iliopsoas impingement by an acetabular cup. a Transverse oblique 12-5 MHz US image obtained over the anterior hip shows a beak-shaped hyperechoic projection (arrowheads) on the anterior border of the acetabular cup surrounded by an effusion (asterisks). Ac, acetabulum. IPs, iliopsoas muscle, b Correlative transverse CT image demonstrates a hyperdense anterior structure (arrowhead) which impinges on the posterior aspect of the iliopsoas muscle (IPs), representing cement leakage following the hip replacement procedure... 

Tlie indi ddual cells are assembled into batteries after a leakage test to check for faulty welding joints in steel containers or cracks and improper seals in the plastic encased cells. Cells that are to be delivered without electroltye are emptied after the fomiation cycles. Tlie steel-cased cells hav e to be separated by mechanical means to prevent intercell shorts and are often assembled into wooden crates. Tlie cells in plastic cases can be cemented together or strapped with tape. 

Another cause of inflammation is leakage of bacteria from the mouth at the interface between the cement and tooth material. Adhesion at the interface reduces this effect. 

Andrews, J. T. Hembree, J. H. (1976). In vivo evaluation of the marginal leakage of four inlay cements. Journal of Prosthetic Dentistry, 35, 532-7. 

Lack of adhesion of a dental restoration to tooth structure results in microleakage at tooth-restoration interface. This occurrence can result in discoloration at the margin of the restoration, or in the formation of caries. Occlusal forces on the restoration and differences between the coeffidents of thermal expansion of the cement and tooth material can lead to leakage. In addition, oral fluids and moisture may affect the adhesion. Microleakage of composite resin restorations has been reviewed by Ben-Amar [233]. Microleakage is not as serious a problem with glass-ionomer cements as it is with resin-based restorative materials, due to reduced polymerization shrinkage [234]. 

Demailly, D., Quirion, R, 2006. C02 abatement, competitiveness and leakage in the European cement industry under the EU ETS grandfathering versus output-based allocation. Climate Policy 6(1), 93-113. 

---