Object. The goal of this study was to quantify volumetrically cement fill and leakage in patients with osteoporotic and metastatic vertebral lesions undergoing percutaneous vertebroplasty and to establish whether these factors have any clinical significance at follow up.Methods. Digital computerized tomography data were retrospectively collected from all cases at the authors' institution in which percutaneous vertebroplasty was performed for osteoporosis or metastatic disease. Patient selection was based on the consensus of a multidisciplinary team consisting of an orthopedic surgeon, an oncologist, and a neuroradiologist. A semiautomated thresholding technique was used to measure vertebral body volume, the volume of cement injected directly into the vertebra, and the volume of cement leakage. Pain-related scores were collected at four early stages of treatment, and all clinical complications were recorded.Cement leakage was found in 87.9% of vertebrae treated with percutaneous vertebroplasty. In osteoporotic vertebrae it occurred mainly in the disc, whereas in metastatic lesions, it was found in multiple areas. Irrespective of leakage, both patients with osteoporotic and metastatic disease experienced significant immediate pain relief postoperatively.Conclusions. Although there was no correlation between cement fill or cement leakage and pain relief, there exists a risk of serious complications due to cement leakage.
KEY WORDS • cement • vertebroplasty • osteoporosis • metastasis • spine • painP J. Neurosurg: Spine / Volume 99 / July, 2003 Abbreviations used in this paper: CT = computerized tomography; VB = vertebral body.
Initial construct stabilities and the effect of reduced bone density were found to be similar between the blade plate and the intramedullary nail in tibiotalocalcaneal arthrodesis, thus implant choice may be based on other clinical factors, such as surgeon preference or soft-tissue status.
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