Risk factor analysis of pulmonary cement embolism during percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures

Abstract

Objective The purpose of this research is to evaluate the risk factors and incidence of pulmonary cement embolism (PCE) during percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) based on postoperative computed tomography (CT). Methods A total of 2344 patients who underwent PVP or PKP due to OVCFs in our spine center were analyzed retrospectively. According to the detection of postoperative pulmonary CT, the patients were divided into two groups: pulmonary cement embolism group (PCE group) and non-pulmonary cement embolism group (NPCE group). Demographic data in both groups were compared using the χ2 test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was carried out to identify risk factors that were significantly related to the PCE resulting from cement leakage. Results PCE was found in 34 patients (1.9% 34/1782) with pulmonary CT examination after operation. There was no statistically significant difference in the parameters such as age, gender, body mass index (BMI), and cement volume in the two groups. Patients with three or more involved vertebrae had a significantly increased risk to suffer from PCE than those with one involved vertebra (p=0.046 OR 2.412 [95% CI 1.017–5.722]). Patients who suffered thoracic fracture had a significantly increased risk to suffer from PCE than those who suffered thoracolumbar fracture (p=0.001 OR 0.241 [95% CI 0.105–0.550]). And significantly increased PCE risk also was observed in thoracic fracture compared with lumbar fracture patients (p=0.028 OR 0.094 [95% CI 0.114–0.779]). The risk of PCE within 2 weeks after fracture was significantly higher than that after 2 weeks of fracture (p=0.000 OR 0.178 [95% CI 0.074–0.429]). Patients who underwent PVP surgery had a significantly increased PCE risk than those who underwent PKP surgery (p=0.001 OR 0.187 [95% CI 0.069–0.509]). Conclusion The real incidence of PCE is underestimated due to the lack of routine postoperative pulmonary imaging examination. The number of involved vertebrae, fracture location, operation timing, and operation methods are independent risk factors for PCE.

CT features and risk factors of pulmonary cement embolism after vertebroplasty or kyphoplasty in patients with vertebral compression fracture: a retrospective cohort study

“…This finding is consistent with the reports of Dohm et al (14). However, Zou et al (13) reported that patients who underwent PVP had a significantly increased risk of PCE compared to those who underwent PKP.…”

“…In the study by Fadili Hassani et al (19), a higher number of treated vertebrae during the PV procedure was an independent risk factor for the occurrence of intracardiac cement embolism. Zou et al (13) indicated that patients with a thoracic fracture have a significantly increased risk of PCE than do those with a thoracolumbar fracture. In our study, we first analyzed the risk of each vertebra for PCE and found PVP or PKP in the T9 vertebra to be a risk factor for PCE.…”

“…However, there are few reports on the computed tomography (CT)-derived imaging characteristics of PCE, the relative incidences of PVP-vs. PKP-induced PCE, and the specific risk factors involved, especially the risk of each vertebra for PCE. Zou et al (13) reported that patients who underwent PVP had a significantly increased PCE risk than did those who underwent PKP. In contrast, a randomized control trial indicated that PKP had fewer cement leakages than did PVP and had a similar incidence of cement embolism (14).…”

Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain

“…[90][91][92] Risks linked to cement extrusion from the vertebra into the spinal canal have been found to be markedly increased for VP. 93 No significant difference was reported for subsequent fractures between the procedures. 94 A meta-analysis comparing complications of percutaneous VP and BKP to treat osteoporotic vertebral compression showed no significative differences regarding subsequent fractures.…”

Risk factors and strategies for recovery quality, postoperative pain, and recurrent fractures between percutaneous kyphoplasty and percutaneous vertebroplasty in elderly patients with thoracolumbar compression fractures: a retrospective comparative cohort study

“…A combination of questionnaires and consultation of clinical information was utilized, including gender, age, body mass index (BMI), degree of fracture, number of injured vertebrae, BMD, and surgical status, with postoperative telephone follow-up or review ( 15 , 16 ). The degree of fracture was evaluated by Genant semi-quantitative method, including mild fracture, moderate fracture, and severe fracture ( 17 ). Double copies were used to independently enter clinical data, with strict quality control, and timely completion or correction of missing or misreported items to ensure the accuracy and integrity of data.…”