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

Dexin Zou,Xifa Wu,Wei Du,Bing Sun,Shengjie Dong

doi:10.1186/s13018-021-02472-9

Abstract

ObjectiveThe 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).MethodsA 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.ResultsPCE 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]).ConclusionThe 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.

Highlights

At present, percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are widely used in osteoporotic vertebral compression fractures (OVCFs), spinal metastasis, and multiple myeloma [1,2,3]
The NPCE group consisted of 1748 patients (703 males and 1045 females), with ages ranging from 56 to 88 years, bone mineral density (BMD) with T-value ranging from −2.5 to −4.6 standard deviation (SD), and injected cement volume of single vertebral body ranging from 4.2 to 8.5 ml
The pulmonary cement embolism (PCE) group consisted of 34 patients (13 males and 21 females), with ages ranging from 57 to 85 years, BMD with T-value ranging from −2.6 to −4.9 SD, and injected cement volume of single vertebral body ranging from 4.0 to 8.7 ml

Summary

Introduction

Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are widely used in osteoporotic vertebral compression fractures (OVCFs), spinal metastasis, and multiple myeloma [1,2,3]. This minimally invasive surgery can effectively relieve pain, maintain the stability of the spine, and prevent further collapse and kyphosis of the spine [4,5,6]. Though in the majority of cases cement leakage does not cause any clinical syndromes, some severe complications can still be encountered during PVP or PKP procedure, such as neurological deficits and pulmonary cement embolism (PCE) [2, 9,10,11]

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