Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Xubing , JIAO Wei , ZHAI Yunlei , ZHANG Wei , LU Haitao , JIANG Jishi , GE Yu ,  YU Haiyang

Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China;

Corresponding?author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Osteoporotic vertebral compression fracture; percutaneous kyphoplasty; bone cement leakage; cortical leakage; complication

DOI：

10.7507/1002-1892.202212066

Video：

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Objective To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra (r=0.493, P<0.001). Conclusion The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.

Citation： HUANG Xubing, JIAO Wei, ZHAI Yunlei, ZHANG Wei, LU Haitao, JIANG Jishi, GE Yu, YU Haiyang. Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 452-456. doi: 10.7507/1002-1892.202212066 Copy

1.	Wang W, Liu Y, Wan H, et al. Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures. BMC Musculoskelet Disord, 2023, 24(1): 11. doi: 10.1186/s12891-022-06125-8.
2.	Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
3.	Li M, Zhang T, Zhang R, et al. Systematic retrospective analysis of risk factors and preventive measures of bone cement leakage in percutaneous kyphoplasty. World Neurosurg, 2023, 171: e828-e836. doi: 10.1016/j.wneu.2022.12.117.
4.	Venmans A, Klazen CA, van Rooij WJ, et al. Postprocedural CT for perivertebral cement leakage in percutaneous vertebroplasty is not necessary-results from VERTOS Ⅱ. Neuroradiology, 2011, 53(1): 19-22.
5.	Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore), 2016, 95(24): e3850. doi: 10.1097/MD.0000000000003850.
6.	Baek IH, Park HY, Kim KW, et al. Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review. BMC Musculoskelet Disord, 2021, 22(1): 741. doi: 10.1186/s12891-021-04625-7.
7.	Hulme PA, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976), 2006, 31(17): 1983-2001.
8.	Chen C, Fan P, Xie X, et al. Risk factors for cement leakage and adjacent vertebral Fractures in kyphoplasty for osteoporotic vertebral fractures. Clin Spine Surg, 2020, 33(6): E251-E255.
9.	李慶達, 賀園, 賀寶榮. 骨質疏松性胸腰椎骨折椎體強化術后并發骨水泥滲漏的若干問題. 中華創傷雜志, 2022, 38(3): 193-197.
10.	Ren H, Feng T, Cao J, et al. A retrospective study to evaluate the effect of dynamic fracture mobility on cement leakage in percutaneous vertebroplasty and percutaneous kyphoplasty in 286 patients with osteoporotic vertebral compression fractures. Med Sci Monit, 2022, 28: e935080. doi: 10.12659/MSM.935080.
11.	Huang S, Zhu X, Xiao D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 452. doi: 10.1186/s13018-019-1499-9.
12.	Zhu SY, Zhong ZM, Wu Q, et al. Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop, 2016, 40(6): 1205-1210.
13.	Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
14.	Baumann C, Fuchs H, Kiwit J, et al. Complications in percutaneous vertebroplasty associated with puncture or cement leakage. Cardiovasc Intervent Radiol, 2007, 30(2): 161-168.
15.	Tomé-Bermejo F, Pi?era AR, Duran-álvarez C, et al. Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture. Spine (Phila Pa 1976), 2014, 39(11): E693-E700.
16.	張陽, 龔維明, 宋宏亮, 等. 骨水泥滲漏與胸腰段椎體血管解剖關系: 105例患者資料回顧性分析. 中國組織工程研究, 2018, 22(34): 5426-5432.
17.	張陽. 骨水泥滲漏與胸腰段椎體血管解剖關系的回顧性分析. 濟南: 濟南大學, 2018.
18.	許正偉, 賀寶榮, 郝定均, 等. 胸腰椎骨質疏松性骨折經皮椎體成形術后骨水泥滲漏的研究進展. 中華骨科雜志, 2016, 36(17): 1142-1148.
19.	張帥, 王清, 楊進, 等. 經皮椎體后凸成形術骨水泥椎管內滲漏發生率及相關危險因素分析. 中國矯形外科雜志, 2018, 26(24): 2244-2249.
20.	張保良, 陳仲強. 椎體強化術后繼發骨水泥滲漏類型及其危險因素的臨床評價. 中華骨科雜志, 2021, 41(5): 330-338.

1. Wang W, Liu Y, Wan H, et al. Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures. BMC Musculoskelet Disord, 2023, 24(1): 11. doi: 10.1186/s12891-022-06125-8.
2. Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
3. Li M, Zhang T, Zhang R, et al. Systematic retrospective analysis of risk factors and preventive measures of bone cement leakage in percutaneous kyphoplasty. World Neurosurg, 2023, 171: e828-e836. doi: 10.1016/j.wneu.2022.12.117.
4. Venmans A, Klazen CA, van Rooij WJ, et al. Postprocedural CT for perivertebral cement leakage in percutaneous vertebroplasty is not necessary-results from VERTOS Ⅱ. Neuroradiology, 2011, 53(1): 19-22.
5. Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore), 2016, 95(24): e3850. doi: 10.1097/MD.0000000000003850.
6. Baek IH, Park HY, Kim KW, et al. Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review. BMC Musculoskelet Disord, 2021, 22(1): 741. doi: 10.1186/s12891-021-04625-7.
7. Hulme PA, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976), 2006, 31(17): 1983-2001.
8. Chen C, Fan P, Xie X, et al. Risk factors for cement leakage and adjacent vertebral Fractures in kyphoplasty for osteoporotic vertebral fractures. Clin Spine Surg, 2020, 33(6): E251-E255.
9. 李慶達, 賀園, 賀寶榮. 骨質疏松性胸腰椎骨折椎體強化術后并發骨水泥滲漏的若干問題. 中華創傷雜志, 2022, 38(3): 193-197.
10. Ren H, Feng T, Cao J, et al. A retrospective study to evaluate the effect of dynamic fracture mobility on cement leakage in percutaneous vertebroplasty and percutaneous kyphoplasty in 286 patients with osteoporotic vertebral compression fractures. Med Sci Monit, 2022, 28: e935080. doi: 10.12659/MSM.935080.
11. Huang S, Zhu X, Xiao D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 452. doi: 10.1186/s13018-019-1499-9.
12. Zhu SY, Zhong ZM, Wu Q, et al. Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop, 2016, 40(6): 1205-1210.
13. Gao C, Zong M, Wang WT, et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol, 2018, 59(5): 577-585.
14. Baumann C, Fuchs H, Kiwit J, et al. Complications in percutaneous vertebroplasty associated with puncture or cement leakage. Cardiovasc Intervent Radiol, 2007, 30(2): 161-168.
15. Tomé-Bermejo F, Pi?era AR, Duran-álvarez C, et al. Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture. Spine (Phila Pa 1976), 2014, 39(11): E693-E700.
16. 張陽, 龔維明, 宋宏亮, 等. 骨水泥滲漏與胸腰段椎體血管解剖關系: 105例患者資料回顧性分析. 中國組織工程研究, 2018, 22(34): 5426-5432.
17. 張陽. 骨水泥滲漏與胸腰段椎體血管解剖關系的回顧性分析. 濟南: 濟南大學, 2018.
18. 許正偉, 賀寶榮, 郝定均, 等. 胸腰椎骨質疏松性骨折經皮椎體成形術后骨水泥滲漏的研究進展. 中華骨科雜志, 2016, 36(17): 1142-1148.
19. 張帥, 王清, 楊進, 等. 經皮椎體后凸成形術骨水泥椎管內滲漏發生率及相關危險因素分析. 中國矯形外科雜志, 2018, 26(24): 2244-2249.
20. 張保良, 陳仲強. 椎體強化術后繼發骨水泥滲漏類型及其危險因素的臨床評價. 中華骨科雜志, 2021, 41(5): 330-338.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty

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