Correlation analysis of the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein in vertebroplasty

Abstract

Objectives To explore the influencing factors of bone cement leakage in the paravertebral vein after vertebroplasty for the treatment of osteoporotic vertebral compression fractures (OVCFs) and to determine the correlation between the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein. Methods This was a retrospective analysis of 495 patients (585 vertebral bodies) with OVCFs treated from August 2018 to May 2021 in our hospital. The patients’ postoperative CT data were imported into Mimics software, and the three-dimensional(3D) reconstruction function was used to calculate the bone cement volume (BCV), puncture-side bone cement volume (PSBCV), and vertebral body volume (VBV); the bone cement/vertebral body volume ratio (BCV/VCV%) and puncture-side bone cement/vertebral body volume ratio (PSBCV/VCV%) were additionally calculated. Sex, Age, Body mass index(BMI), Bone density, BCV, PSBCV, VBV, BCV/VCV%, and PSBCV/VCV were compared between the leakage group and the non-leakage group. Logistic regression analysis was used to assess the correlations between the factors that statistically significantly differed between the two groups and the presence of leakage in the paravertebral veins. A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of the PSBCV/VCV% and to obtain the optional cut-off value. Results A total of 102 males and 393 females with an average age of 72.89 (52 ~ 93) years were included in our study. There were 57 cases of cement leakage (59 vertebral bodies) in the paravertebral vein. There were 438 patients (526 vertebral bodies) without paravertebral cement leakage. Univariate analysis showed that the differences in sex, bone density, PSBCV, and PSBCV/VCV% between the two groups were statistically significant (P < 0.05). Logistic regression analysis showed that there were correlations between sex, bone density, and PSBCV/VCV% and the presence of paravertebral cement leakage (P < 0.05). The ROC curve showed that the area under the curve of the PSBCV/VCV% for the diagnosis of cement leakage in the paravertebral vein was greater than 0.65, and P < 0.05, indicating a diagnostic value. The best cut-off point for the diagnosis of paravertebral cement leakage with the PSBCV/VCV% was 13.68%, with a sensitivity of 84.7% and specificity of 37.8%. Conclusion Sex, bone density, and PSBCV/VCV% are risk factors for cement leakage in the paravertebral veins after vertebroplasty for the treatment of OVCFs; the PSBCV/VCV% is strongly associated with paravertebral venous leakage, and the optimal PSBCV/VCV% is 13.68%. When the PSBCV/VCV% exceeds the optimal value, the risk of cement leakage in the paravertebral vein becomes significantly increased.

A novel puncture approach via point “O” for percutaneous kyphoplasty in patients with L4 or L5 osteoporotic vertebral compression fracture

“…The larger the bone cement volume, the higher the risk of cement leakage 27 . Several researchers have speculated that when the bone cement volume ratio of the punctured side exceeds the optimal ratio of 13.68%, there is a significant increase in bone cement leakage in the paravertebral vein 28 . To reduce the risk of cement leakage, the optimal volume of low-viscosity bone cement requires reduction 29 .…”

Safety and prognosis of repeated vertebroplasty in the treatment of osteoporotic vertebral fractures

“…PVP usually has a high leakage rate, which has been reported to be as high as 63-87% in the literature (21). With the advancement of technology, the leakage rate is gradually decreasing, cortical disruption, basivertebral foramen, low bone cement viscosity, female, low bone density, bone cement volume/vertebral body volume > 13.68% were the strongest risk factors (22)(23)(24). Fadili Hassani S et al (25) analyzed 1512 patients treating with vertebral augmentation and found that the incidence of postoperative pulmonary cement embolisms was 24%, and the incidence of intracardiac cement embolisms was 3.9%.…”

Current status and challenges of percutaneous vertebroplasty (PVP)

“…In the medical community, it is known that the satisfaction a patient feels after receiving a treatment that is valuable plus a good relationship with the treating medical staff are effective in providing the pain relief and a better QOL for the patient. In contrast, the circumstances that caused a patient's OVF, treatment-related bad feelings, anxiety about the future, and/or worsening relationships around the patient Adverse events Serious adverse events related to PVP [3,48,49] 1.1-3.3% Direct deaths from PVP [87] 0.0018-0.002% Bone cement leakage [3,24,48,49,51] 34-91.3% Symptomatic bone cement leakage [79] 1.08% Venous cement leakage detected by CT [62,91,92] 12-26% Pulmonary cement embolism Detection by chest radiograph [62] 1.0-6.8% Detection by chest CT [62] 2.1-26% Symptomatic pulmonary embolism [69] 0.40% Respiratory disorders other than cement embolism [49,80] 0.2-0.4% Cardiac cement embolism [70] 3.90% Symptomatic cardiac embolism [70] 0.33% Cardiac dysfunction other than cement embolism…”

“…Venous cement leakage of patients treated with PVP occurs in 12–26% detected by CT [ 62 , 91 , 92 ], and a cardiac cement embolism may further migrate to the right ventricle and pulmonary artery [ 63 ]. The reported incidence of intracardiac cement embolism after PV was 72/1854 sessions (3.9%), of these, only 5 cases (0.33%) were symptomatic [ 70 ].…”