Tactile feedback allows accurate insertion of a powered bone access device for vertebroplasty and bone marrow sampling procedures

Purpose: A new powered device is available for vertebroplasty, bone marrow biopsy and other procedures. Some have questioned whether the ease of insertion can lead to penetrating the opposite cortex of the bone. A study was designed to determine the relative precision of needle placement using only tactile feedback. Materials and Methods: Three different FDA-cleared 11 gauge stainless steel needle types were compared in a randomized prospective study test blocks of artificial bone. The needle types were “Manual” inserted (“Manual” World Wide Medical Technologies Bone Marrow Biopsy Needle “J” style, Oxford, CT), “Hammer-assisted” (“Hammer” ArthoCare Spine Parallax Clear-View Access Needle, Austin, TX), and rotary “Power”-inserted (“Power” On Control Bone Marrow Biopsy Needle, Vidacare Corp., Shavano Park, Texas). Test blocks were designed with 3 different thicknesses each simulating the characteristics of human bone. Eleven clinicians participated in the study. Following each insertion, the participant was asked to rate the confidence level of insertion accuracy on a scale of 0-10. Position of the needle tip was assessed by fluoroscopic confirmation. Each participant also inserted each needle type into a simulated osteoporotic bone model (raw chicken egg). The ability to insert the needle into the egg without damage was based on visual assessment. Data were analyzed using SPSS for Windows. Results: In simulated bones, mean insertion times in seconds were Manual 20.7 ± 10.1, Hammer 12.7 ± 5.9, Power 8.7 ± 2.8. Differences were significant (p<.001). Insertion success was Manual 48.5%, Hammer 69.7%, Power 97.0%; statistically significant (p<.001). Mean insertion certainty levels were: Manual 48%, Hammer 61%, Power 91%; statistically significant (p<.05). Egg insertion without damage rates were Manual 19.2%, Hammer 36.4%, Power 100%; statistically significant (p<.001). Conclusion: Powered insertion may be preferred over “Manual” or “Hammer”-assisted insertions. Using tactile feedback only, the powered device may allow precise needle placement with greater success and confidence than with traditional devices. Powered insertion may facilitate penetration into fragile bones without damage.