Complication Pattern After Percutaneous Cement Discoplasty: Identification of Factors Influencing Reoperation and Length of Hospital Stay

Abstract

Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine in a minimally invasive way. The aim of the present study was to analyse the complication pattern after PCD and to identify factors that predict the chance of cement leakage, reoperation and length of hospital stay (LOS). 344 patients were treated with PCD within the study period. Clinical features and complications were analysed by applying descriptive statistics, while perioperative factors predictive of cement leakage, reoperation and LOS were identified by regression models. Cement leakage rate was 30.4 % in the total cohort, however only fifth of them were symptomatic. Cement leakage itself did not have a significant influence on clinical outcome. Other complications and non-surgical adverse events were registered only in 2.0% of cases. Age, BMI, low viscosity cement, lower level of surgeon's experience and the number of operated levels were identified as risk factors of cement leakage (p<0.01, c-index=0.807). Type of procedure, Charlson comorbidity score, reoperation and non-surgical adverse events significantly increased the LOS (p<0.01). Cement leakage, early surgical practice and high BMI were risk factors for reoperation (p<0.01, c-index=0.72). In summary, PCD is a relatively safe and effective procedure for treating spinal instability due to advanced stage disc degeneration characterized by vacuum phenomenon. Cement leakage is not uncommon but only a radiologic complication without clinical consequences in most cases. On the other hand, it can increase the LOS and it is a significant risk factor for reoperation.