Impact of Cement Placement and Leakage in Osteoporotic Vertebral Compression Fractures Followed by Percutaneous Vertebroplasty

Abstract

Retrospective study. Assessment of the impact of cement placement and leakage in osteoporotic vertebral compression fractures (OVCFs) followed by percutaneous vertebroplasty (PVP) on patient pain relief and new vertebral fracture occurrence. Previous studies have not specifically addressed cement placement in the context of pain outcomes and subsequent vertebral fracture. We included a total of 192 patients who underwent PVP for OVCFs. We assessed imaging data, and patients rated their pain over a 24-month period. The patients were divided into 3 groups based on image analysis: group 1 [31 cases: 5 thoracic, 15 thoracolumbar (TL) junction, 11 lumbar] included patients with no cement extension to the endplate(s), group 2 (121 cases: 19 thoracic, 64 TL junction, 38 lumbar) was comprised of patients with cement extension to the endplate(s) but no leakage into the disk space, and group 3 (40 cases: 8 thoracic, 21 TL junction, 11 lumbar) included patients with cement extension to the endplate(s) and leakage into the disk space(s). We assessed the correlation between cement location and pain ratings and changes in pain scores, as well as the proportions of new fracture. Postprocedure pain numeric scores and changes in pain scores were similar among the 3 groups (P>0.05). Cement location did not significantly correlate with pain ratings or changes in pain scores for any follow-up points. There was no significant difference in new adjacent fracture rate among the groups (P>0.05). Neither extension of cement to the endplate nor cement leakage into the disk space had a significant impact on postprocedural pain. Furthermore, intradisk cement leakage was not a risk factor for new fracture after PVP in patients with OVCF. However, lower fill volumes should be used to lessen the risk of leakage.