Department of Neurosurgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2011 May 20;36(12):E761-72. doi: 10.1097/BRS.0b013e3181fc914e.
Prospective study.
The aim of this study was to demonstrate the safe range of cement volume during percutaneous vertebroplasty.
A few clinical reports have addressed the relationship between cement volume and clinical outcome. However, the weakness of these studies was that subjects included were not homogeneous. No study in the clinical setting has confirmed results from biomechanical and computational studies.
We examined 96 patients with single compression fractures who underwent percutaneous vertebroplasty and postoperative three-dimensional CT scan within a week between June 2006 and April 2009. The volume and fraction were measured by a CT volumetry program. Relationships between predictors and volumetric data, outcome, leakage, intraverterbal vacuum cleft (IVVC), and subsequent fracture were examined. Relationships between volumetric data and outcome, leakage, IVVC, and subsequent fracture were analyzed with stratification by the treated level. Receiver-operator characteristic (ROC) curves were plotted to acquire cut-off values of volumetric data.
Seventy-three patients (76%) were female, and the mean age was 76.3 ± 8.4 years (range 53-97). The mean duration of follow-up was 11 months (range 6-21). Locations were as follows: T4-T10 9, T11-L1-L57, and L2-L4 30. Seventy-eight patients (81%) reported a favorable outcome. Fractured body volume (FBV) and the level treated were associated with fraction, which had an influence on outcome. The fraction of the favorable group was significantly higher. Cut-off values to acquire a favorable outcome were 11.64% (P = 0.026) on the T4-L4 level and 3.35 cm (P = 0.059), 11.65% (P = 0.059) on the T11-L1 level. Group with intradiscal leakage had a smaller volume than nonleakage group on the L2-L4 level (3.86 cm vs. 5.65 cm, P = 0.002). There were no relationships of volumetric data with epidural leakage and pulmonary embolism. The presence of IVVC increased volume on the T4-L4 and L2-L4 level (P < 0.03). Larger volume increased significantly the incidence of adjacent fracture on the L2-L4 level. The significant cut-off volume to avoid adjacent fracture was 4.90 cm on the ROC curve.
It is suggested that fraction is superior to volume for predicting outcome on the T11-L1 level and an amount of cement should be determined in terms of FBV and fraction according to the treated level. A lower fraction than required for the restoration of mechanical property was enough to obtain pain relief. Intradiscal leakage on the L2-L4 level may be inevitable to obtain appropriate mechanical properties in the case of severe endplate breakdown connected with the disc space. Smaller volume is needed to avoid an adjacent fracture on the L2-L4 level. Although we did not know the reason why there was a difference among the treated level groups, one thing that is certain is the fact that level-specific approaches may be necessary for good outcome in terms of volume, fraction and FBV.
前瞻性研究。
本研究旨在证明经皮椎体成形术中水泥体积的安全范围。
一些临床报告已经探讨了水泥体积与临床结果之间的关系。然而，这些研究的弱点是，所纳入的受试者并不具有同质性。在临床环境中，尚无研究证实生物力学和计算研究的结果。
我们检查了 96 例在 2006 年 6 月至 2009 年 4 月期间接受经皮椎体成形术和术后一周内三维 CT 扫描的单压缩骨折患者。使用 CT 体积测量程序测量体积和分数。研究了预测因子与体积数据、结果、渗漏、椎体间真空裂隙（IVVC）和随后骨折之间的关系。通过分层治疗水平分析体积数据与结果、渗漏、IVVC 和随后骨折之间的关系。绘制受试者工作特征（ROC）曲线以获得体积数据的截断值。
73 例（76%）为女性，平均年龄为 76.3±8.4 岁（53-97 岁）。平均随访时间为 11 个月（6-21 个月）。部位如下：T4-T10 9 例，T11-L1-L57 例，L2-L4 例 30 例。78 例（81%）患者报告预后良好。骨折体体积（FBV）和治疗水平与分数有关，分数对结果有影响。优良组的分数明显更高。在 T4-L4 水平和 3.35cm（P=0.059）、11.65%（P=0.059）时，获得良好预后的截断值分别为 11.64%（P=0.026）。T11-L1 水平。L2-L4 水平的椎间盘内渗漏组的体积明显小于非渗漏组（3.86cm 比 5.65cm，P=0.002）。体积数据与硬膜外渗漏和肺栓塞无关系。IVVC 的存在增加了 T4-L4 和 L2-L4 水平的体积（P<0.03）。较大的体积显著增加了 L2-L4 水平的相邻骨折发生率。避免相邻骨折的显著截断体积在 ROC 曲线上为 4.90cm。
建议在 T11-L1 水平，分数优于体积来预测结果，并且应根据治疗水平根据 FBV 和分数来确定水泥量。为了获得疼痛缓解，恢复机械性能所需的分数可能是足够的。在与椎间盘空间相连的严重终板破裂的情况下，为了获得适当的机械性能，L2-L4 水平的椎间盘内渗漏可能是不可避免的。L2-L4 水平需要较小的体积以避免相邻骨折。尽管我们不知道为什么在治疗水平组之间存在差异，但有一件事是肯定的，即就体积、分数和 FBV 而言，针对特定水平的方法可能是获得良好结果所必需的。
