Using Curved Balloons and Needles for Improved Cement Distribution

[Aaron Fritts]
Equipment wise, I'm actually a big fan of the new curved balloons and needles on the market and I've gone unilateral on several of my recent cases, both T and L-spine. I'd like to know your experiences with the curved balloons and needles and if you guys use it much.

[Venu Vadlamudi]
I have used and like the new curved needles from Stryker, for example. I've used those on a few cases and I've had very nice cement distribution. DFINE, which is now part of Merit, they have their flexible curved osteotome, which is a nice device. Especially the newest iteration of it. [It’s] more rigid and robust, I think, and really can create some nice channels for cement distribution.

And so I think those adjuncts can allow for a unipedicular approach in most cases. I think in our practice, a lot of the cases that we do tend to be unipedicular.

[Kumar Madassery]
Yeah, I agree, I agree with Venu that the curved needle from Stryker [has] given a lot of ease and approach, especially of the thoracic spine, because it gives you a lot more leeway for not having to be such a lateral to medial approach. I do like that aspect of it.

And also with the Merit, I find the curved curette gives you a lot of maneuverability in creating your channels that you're doing. We also have the Medtronic one but I think the curved needle particularly has helped. [It] gives you a lot more forgiveness in there because the biggest thing you try to teach the fellows is imagine the pedicle as a clock face and how you're going to really strive to get to that across the midline, the curved needle itself on that really helps you.

So what whatever you're doing I think the advantage of that is the importance is getting to the right spot and that comes with, as we've all learned, is just practice, experience and a lot of fear in the beginning.

[Aaron Fritts]
Yeah, even cranio-caudally, you know, if you have a superior end plate fracture, [or] an inferior end plate fracture, you can direct that needle up or down nicely, which is what I like about it. Just to get it, like you guys said, just to get it in the right spot and once you find that fracture line, the cement just kind of goes in the pathway of least resistance.

[Venu Vadlamudi]
Yeah, I agree completely. And often with those paralleling fractures, which they very often are, I often will try to get the needle right into that cleft. Like you said, the cement's going to go in and nicely and distribute right across that cleft, that fracture line. Usually if I get that, that may be enough of a stopping point. I don't necessarily need to have cement go all the way from the top to the bottom if I can get it right across that fracture plane. That may be enough to get that stabilization and pain relief and often that's what translates clinically.