3:18 PM Abstract No. 348 Percutaneous augmentation for osteoporotic and malignant vertebral body compression fractures: an institutional experience

Abstract

To identify risk factors for complications of percutaneous vertebral augmentation (PVA). A retrospective study of PVAs performed by a single interventionalist at our academic community and tertiary cancer care hospitals from April 2007-August 2019 was performed. Demographics included age, sex, BMI, smoking history, fracture etiology and malignancy. Procedural variables included vertebroplasty vs. kyphoplasty, adjuncts such as radiofrequency ablation, level(s), trocar gauge, laterality, cement volume and early complications. Patients with less than 30 days follow-up were excluded. Cross sectional imaging (CSI) of augmented levels was reviewed. Significance was determined by the chi-square test. 134 patients (74 with osteoporosis and 60 with malignancy) undergoing augmentation of 256 levels during 154 procedures met inclusion criteria [59 (44.0%) males, median (range) age of 71 (38-88) years old]. Pulmonary cement embolism occurred in 8 patients (5% of procedures), including 1 symptomatic patient who also had emphysema. 2 were admitted for anesthesia complications (2%) and 3 for pain control (2%). 1 of these had imaging findings to explain their pain, requiring decompression for a retropulsed malignant fracture fragment. Of 174 levels visualized by CSI, 75 (43%) had posterior extravasation of cement into the spinal canal. This was noted on fluoroscopy for 4 (2%) levels. Stenosis was insignificant in 33 (19%), mild in 30 (17%), moderate in 10 (6%) and severe in 2 (1%). None showed worsening neurologic symptoms in the immediate postprocedural period. No factors analyzed showed significant increase in risk of posterior extravasation. The odds ratio for malignant fractures was 1.5 that of osteoporotic fractures (P = 0.224), 0.7 for bipedicular access (P = 0.230) and 0.5 (P = 0.081) for kyphoplasty. Complications of PVA are often subclinical, though may be augmented by comorbidities. While fluoroscopy underestimates incidence of posterior extravasation, routine CSI is not warranted. Malignant fractures may pose a higher risk for posterior extravasation. Kyphoplasty and bipedicular approach may be preferable techniques. Further study with a larger sample size is required.