Journal List > J Korean Soc Spine Surg > v.21(4) > 1076029

Kim, Ahn, Yang, Yi, Im, Lee, Yang, Nam, and Kim: Cement Leakage after Vertebroplasty; Correlation with Patterns of Compression Fractures and Bone Mineral Density (BMD)

Abstract

Study Design

Retrospective study

Objectives

To analyze the influence of fracture patterns and the result of bone mineral density on cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

Summary of Literature Review

Leakage of bone cement after vertebroplasty has known to be related with the direction of cortical disruption of fractured vertebral body and low bone mineral density (BMD).

Materials and Methods

One hundred eighty-two patients with osteoporotic vertebral compressions were studied from January 2009 to August 2013. The patients’ fracture levels and patterns were compared. Among them, the cement leakage patterns were analyzed in 105 patients who had undergone vertebroplasty. The findings were compared with fracture patterns including cortical disruption and BMD.

Results

Seventy-five cases of cement leakage were observed. Among them, intradiscal leakage was the most common type of leakage. In the patient group with low BMD, there was a high incidence of lower and posterior cortical disruption in the fractures. Patients with posterior cortical disruption demonstrated a higher incidence of leakage into the spinal canal and anterior cortex. No significant correlation was observed between fracture patterns and leakage.

Conclusions

A surgeon should use caution in performing vertebroplasty in patients with low BMD and posterior disruption of the vertebral cortex.

REFERENCES

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Table 1.
Levels and types of fractured vertebrae
Total Group 1 Vertebroplasty Group 2 Conservative p-value
No. of cases 182 105 77
Age 73.6±10.3 (52~95) 76.3±7.3 (55~91) 69.6±12.5 (52~95) <0.01
Level of Fractured Vertebra
 L1 51 25 26 0.139
 T12 32 27 15 0.324
 L2 42 14 18 0.078
 Others 57 39 18 0.047
Fracture type
 Wedge 131 72 59 0.232
 Biconcave 43 27 16 0.438
 Collapse 8 6 2 0.310
Table 2.
Levels and types of fractured vertebrae according to BMD in vertebroplasty group
T-Score Total (N=105) Over -3.0 (N=38) -3.0~-4.0 (N=41) Below -4.0 (N=26) p-value
Fracture type
 Wedge 72 29 27 16 0.407
 Biconcave 27 8 12 7 0.696
 Collapse 6 1 2 3 0.307
Cortical disruptions observe ed
 Superior 59 20 24 15 0.923
 Anterior 53 22 21 10 0.309
 Interior 29 6 12 11 0.063
 Posterior 24 9 7 8 0.325
 None 21 7 10 4 0.637
Monocortical disruption
 Superior 10 4 4 2 0.928
 Anterior 10 5 3 2 0.632
 Posterior 3 1 0 2 0.182
 Interior 1 0 1 0 0.454
Bicortical disruption
 Antero-Superior 20 9 8 3 0.417
 Infero-Superior 12 2 4 6 0.093
 Antero-Posterior 7 4 2 1 0.437
 Postero-Superior 3 1 1 1 0.944
 Antero-Inferior 1 0 0 1 0.224
 Postero-Inferior 1 0 1 1 0.532
Tricortical disruption
 Antero-Supero-Inferior 6 2 4 0 0.250
 Antero-Postero-Superior 2 1 1 0 0.704
 Antero-Postero-Inferior 2 1 1 0 0.704
 Whole four cortex disrupt ion 5 0 2 3 0.113
Table 3.
Type of cement leakage after vertebroplasty
T-Score Total (N=105) Over -3.0 (N=38) -3.0~-4.0 (N=41) Below -4.0 (N=26) p-value
No leakage 30 14 9 7 0.334
Leakage observed in
 Intervertebral space 51 16 23 12 0.443
 Anteroposterior view 47 18 19 10 0.754
 Posterior canal 19 2 7 10 <0.01
Monocortical leakage in
 Anteroposterior view 12 6 5 1 0.330
 Intervertebral space 18 5 10 3 0.284
 Posterior canal 7 1 3 3 0.365
Complex leakage
 Anteroposterior view and Intervertebral space 26 11 10 5 0.674
 Anteroposterior view and Posterior canal 5 1 1 3 0.173
 Intervertebral space and Posterior canal 3 0 0 3 <0.01
 Anteroposterior view, Intervertebral space and Posterior canal 4 0 3 1 0.236
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