A Retrospective Study to Evaluate the Effect of Dynamic Fracture Mobility on Cement Leakage in Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in 286 Patients with Osteoporotic Vertebral Compression Fractures

Abstract

Background Cement leakage is the most common complication following percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Dynamic fracture mobility was determined by comparing preoperative standing lateral radiographs with intraoperative prone lateral radiographs. This retrospective study from a single center aimed to evaluate the effect of dynamic fracture mobility on cement leakage in PVP and PKP in 286 patients with OVCFs. Material/Methods Records of patients who underwent PVP or PKP in our department between January 2016 and December 2019 were retrospectively analyzed, showing that 156 patients received PVP and 130 patients received PKP. Variables that were significantly related to presence of cement leakage in the univariate analysis were subsequently included in a multivariate logistic regression analysis for determining the independent risk factors for cement leakage. Results The univariate analysis showed that dynamic fracture mobility ( P <0.001), operative approach ( P =0.026), peripheral vertebrae wall damage ( P <0.001), intravertebral cleft ( P <0.001), and cement volume injected ( P <0.001) were correlated with cement leakage. Factors that showed differences by univariate analysis underwent multivariate logistic regression analysis, showing that peripheral vertebrae wall damage (OR=11.774,95% CI 4.384–31.619, P =0.000), dynamic fracture mobility (OR=5.884, 95% CI 2.295–15.087, P =0.000), operative approach (OR=3.143, 95% CI 1.136–8.698, P =0.027), and cement volume injected (OR=1.486, 95% CI 1.119–1.973, P =0.006) were independent risk factors for postoperative cement leakage. Conclusions This retrospective study showed that dynamic fracture mobility, peripheral vertebrae wall damage, operative approach, and cement volume injected were risk factors for cement leak following PVP and PKP.

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

“…Kyphoplasty also produces better immediate postoperative kyphosis correction and less progressive kyphotic degeneration than vertebroplasty and nonsurgical treatments [ 45 ]. The high incidence of cortical defects and instability of crushed vertebrae in TLBFs has been attributed to bone cement leakage [ 46 , 47 ]. Improvement in the components of conventional high-viscosity PMMA bone cement is necessary to prevent cement leakage [ 48 ].…”

Comparison of Unilateral and Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

“…There is some controversy regarding the amount of bone cement injected; it has been suggested that the more adequate the dispersion of the bone cement, the better the pain relief; however, a higher amount of bone cement injected is more likely to trigger the risk of adjacent vertebral fracture and the probability of bone cement leakage. [19][20][21] Furthermore, bone cement leakage is a common postoperative complication of PKP, which may lead to nerve compression, and stimuli such as bone cement toxicity or allergy can cause symptoms such as decreased blood pressure and dyspnoea. 20,22 And, without compromising clinical outcomes, unilateral puncture requires only one set of puncture equipment, which can save patients' hospitalization costs.…”

Extra-facet puncture PVP in the treatment of osteoporotic vertebral compression fractures

“…Characterized by minimally invasive and immediate pain relief, PVP is the most widely used treatment for osteoporotic vertebral compression fractures [18,19]. In spite of this, there are still some procedural complications such as cemented vertebral recollapse, adjacent vertebral fractures, cement leakage as well as facet joint violation [20][21][22][23][24][25]. Furthermore, some studied reported that unsatis ed bone cement distribution, low bone cement volume and individual factors such as fascia oedema, paraspinal muscle degeneration and intervertebral cleft could also cause residual back pain and adversely affected the patient's quality of life [8].…”