CORRELATION ANALYSIS OF CEMENT LEAKAGE WITH VOLUME RATIO OF INTRAVERTEBRAL BONE CEMENT TO VERTEBRAL BODY AND VERTEBRAL BODY WALL INCOMPETENCE IN PERCUTANEOUS VERTEBROPLASTY FOR OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANGDe ¹ , YELinqiang ² ,  JIANGXiaobing ¹ , HUANGWeiquan ¹ , YAOZhensong ¹ , TANGYongchao ¹ , ZHANGShuncong ¹ , JINDaxiang ¹

1. Department of Spinal Surgery, No. 1 Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. First Clinical Medical College, Guangzhou University of Chinese Medicine;

Corresponding author：

JIANGXiaobing, Email: spinedrjxb@sina.com

Keywords：

Percutaneous vertebroplasty; Osteoporotic vertebral compression fracture; Cement leakage; Volume ratio of intravertebral bone cement to vertebral body; Vertebral body wall incompetence

DOI：

10.7507/1002-1892.20140294

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Objective To investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods Between March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. Results All procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. Conclusion The volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.

Citation： LIANGDe, YELinqiang, JIANGXiaobing, HUANGWeiquan, YAOZhensong, TANGYongchao, ZHANGShuncong, JINDaxiang. CORRELATION ANALYSIS OF CEMENT LEAKAGE WITH VOLUME RATIO OF INTRAVERTEBRAL BONE CEMENT TO VERTEBRAL BODY AND VERTEBRAL BODY WALL INCOMPETENCE IN PERCUTANEOUS VERTEBROPLASTY FOR OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1358-1363. doi: 10.7507/1002-1892.20140294 Copy

1.	Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology, 2003, 226(2):366-372.
2.	郑召民.经皮椎体成形术和经皮椎体后凸成形术灾难性并发症--骨水泥渗漏及其预防.中华医学杂志, 2006, 86(43):3027-3030.
3.	Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty:an experimental model and study on cement leakage. Spine (Phila Pa 1976), 2006, 31(22):2562-2568.
4.	Ren H, Shen Y, Zhang YZ, et al. Correlative factor analysis on the compl ications resulting from cement leakage after percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. J Spinal Disord Tech, 2010, 23(7):e9-15.
5.	江晓兵, 黄伟权, 庞智晖, 等.基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法.中国脊柱脊髓杂志, 2013, 23(3):238-243.
6.	Hiwatashi A, Ohgiya Y, Kakimoto N, et al. Cement leakage during vertebroplasty can be predicted on preoperative MRI. AJR Am J Roentgenol, 2007, 188(4):1089-1093.
7.	Koh YH, Han D, Cha JH, et al. Vertebroplasty:magnetic resonance findings related to cement leakage risk. Acta Radiol, 2007, 48(3):315-320.
8.	Yeon JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(1):83-89.
9.	Silverman SL. The cl inical consequences of vertebral compression fracture. Bone, 1992, 13 Suppl 2:S27-31.
10.	Lee MJ, Dumonski M, Cahill P, et al. Percutaneous treatment of vertebral compression fractures:a meta-analysis of complications. Spine (Phila Pa 1976), 2009, 34(11):1228-1232.
11.	Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate:a case report. Spine (Phila Pa 1976), 2002, 27(19):E419-422.
12.	Habib N, Maniatis T, Ahmed S, et al. Cement pulmonary embolism after percutaneous vertebroplasty and kyphoplasty:an overview. Heart Lung, 2012, 41(5):509-511.
13.	Chen WJ, Kao YH, Yang SC, et al. Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech, 2010, 23(1):35-39.
14.	Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976), 2001, 26(14):1537-1541.
15.	Hong SJ, Lee S, Yoon JS, et al. Analysis of intradiscal cement leakage during percutaneous vertebroplasty:Multivariate study of risk factors emphasizing preoperative MR findings. J Neuroradiol, 2014, 41(3): 195-201.
16.	Jin YJ, Yoon SH, Park KW, et al. The volumetric analysis of cement in vertebroplasty:relationship with cl inical outcome and complications. Spine (Phila Pa 1976), 2011, 36(12):E761-772.
17.	Nieuwenhuijse MJ, Bollen L, van Erkel AR, et al. Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2012, 37(20):1747-1755.
18.	Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res, 1993, 8(9): 1137-1148.
19.	Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:identification of risk factors. Spine J, 2011, 11(9):839-848.

1. Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology, 2003, 226(2):366-372.
2. 郑召民.经皮椎体成形术和经皮椎体后凸成形术灾难性并发症--骨水泥渗漏及其预防.中华医学杂志, 2006, 86(43):3027-3030.
3. Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty:an experimental model and study on cement leakage. Spine (Phila Pa 1976), 2006, 31(22):2562-2568.
4. Ren H, Shen Y, Zhang YZ, et al. Correlative factor analysis on the compl ications resulting from cement leakage after percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. J Spinal Disord Tech, 2010, 23(7):e9-15.
5. 江晓兵, 黄伟权, 庞智晖, 等.基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法.中国脊柱脊髓杂志, 2013, 23(3):238-243.
6. Hiwatashi A, Ohgiya Y, Kakimoto N, et al. Cement leakage during vertebroplasty can be predicted on preoperative MRI. AJR Am J Roentgenol, 2007, 188(4):1089-1093.
7. Koh YH, Han D, Cha JH, et al. Vertebroplasty:magnetic resonance findings related to cement leakage risk. Acta Radiol, 2007, 48(3):315-320.
8. Yeon JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg (Br), 2003, 85(1):83-89.
9. Silverman SL. The cl inical consequences of vertebral compression fracture. Bone, 1992, 13 Suppl 2:S27-31.
10. Lee MJ, Dumonski M, Cahill P, et al. Percutaneous treatment of vertebral compression fractures:a meta-analysis of complications. Spine (Phila Pa 1976), 2009, 34(11):1228-1232.
11. Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate:a case report. Spine (Phila Pa 1976), 2002, 27(19):E419-422.
12. Habib N, Maniatis T, Ahmed S, et al. Cement pulmonary embolism after percutaneous vertebroplasty and kyphoplasty:an overview. Heart Lung, 2012, 41(5):509-511.
13. Chen WJ, Kao YH, Yang SC, et al. Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech, 2010, 23(1):35-39.
14. Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976), 2001, 26(14):1537-1541.
15. Hong SJ, Lee S, Yoon JS, et al. Analysis of intradiscal cement leakage during percutaneous vertebroplasty:Multivariate study of risk factors emphasizing preoperative MR findings. J Neuroradiol, 2014, 41(3): 195-201.
16. Jin YJ, Yoon SH, Park KW, et al. The volumetric analysis of cement in vertebroplasty:relationship with cl inical outcome and complications. Spine (Phila Pa 1976), 2011, 36(12):E761-772.
17. Nieuwenhuijse MJ, Bollen L, van Erkel AR, et al. Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2012, 37(20):1747-1755.
18. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res, 1993, 8(9): 1137-1148.
19. Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD. Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures:identification of risk factors. Spine J, 2011, 11(9):839-848.

Chinese Journal of Reparative and Reconstructive Surgery

CORRELATION ANALYSIS OF CEMENT LEAKAGE WITH VOLUME RATIO OF INTRAVERTEBRAL BONE CEMENT TO VERTEBRAL BODY AND VERTEBRAL BODY WALL INCOMPETENCE IN PERCUTANEOUS VERTEBROPLASTY FOR OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

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