Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Spine J. 2011 Sep;11(9):839-48. doi: 10.1016/j.spinee.2011.07.027. Epub 2011 Sep 1.
Percutaneous vertebroplasty (PVP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). The complication rate of PVP is low, but cement leakage occurs in up to 90% of the treated levels. Recent evidence suggests that sequelae of cement leakage may be more common and clinically relevant than previously thought. Preoperative appreciation of risk factors would therefore be helpful but has not been thoroughly investigated.
Identification of preoperative risk factors for the occurrence of cement leakage in PVP for painful OVCFs.
Retrospective assessment of risk factors using multivariate analysis.
Eighty-nine patients treated with PVP for 177 painful OVCFs.
Occurrence of cement leakage.
The influence of all known risk factors and other parameters potentially affecting the occurrence of cement leakage was retrospectively assessed using multivariate analysis. Patient age, sex, and spinal deformity index; fracture age, level, type, and semiquantitative severity grade (1-4), the presence of an intravertebral cleft and/or cortical disruption on preoperative magnetic resonance imaging (MRI), and the viscosity of bone cement were included. Cement leakage was assessed on direct postoperative computed tomography scanning of the treated levels. In addition to cement leakage in general, three fundamentally different leakage types (cortical, epidural, and anterior venous), with different possible clinical sequelae, were discerned, and their respective risk factors were assessed.
In 130 of 173 (75.1%) treated OVCFs, cement leakage was detected. Leakage incidence was found to increase approximately linear with advancing severity grade. High fracture semiquantitative severity grade (adjusted per grade relative risk [RR], 1.14; 95% confidence interval [CI], 1.05-1.24; p=.002) and low bone cement viscosity (medium vs. low viscosity: adjusted RR, 0.73; 95% CI, 0.61-0.87; p<.001) were strong risk factors for cement leakage in general. For cortical leakage (in 95% intradiscal leakage), the presence of cortical disruption on MRI (adjusted RR, 1.62; 95% CI, 1.16-2.26; p=.004) and an intravertebral cleft on MRI (adjusted RR, 1.43; 95% CI, 1.07-1.77; p=.017) were identified as additional strong risk factors.
High fracture severity grade and low viscosity of polymethylmethacrylate bone cement are general, strong, and independent risk factors for cement leakage. Using MRI assessment, cortical disruption and the presence of an intravertrebral cleft were identified as additional strong risk factors regarding cortical (intradiscal) cement leakage, thereby potentiating anticipation.
经皮椎体成形术（PVP）是治疗疼痛性骨质疏松性椎体压缩性骨折（OVCFs）的常见方法。PVP 的并发症发生率较低，但在治疗的所有水平中，高达 90%的患者会出现水泥渗漏。最近的证据表明，水泥渗漏的后遗症可能比以前认为的更常见和更具临床意义。因此，术前了解危险因素会有所帮助，但尚未进行彻底研究。
确定经皮椎体成形术（PVP）治疗疼痛性 OVCFs 时发生水泥渗漏的术前危险因素。
使用多变量分析对危险因素进行回顾性评估。
89 例接受 PVP 治疗的 177 例疼痛性 OVCFs。
水泥渗漏的发生情况。
使用多变量分析回顾性评估所有已知的危险因素和其他可能影响水泥渗漏发生的参数。患者年龄、性别和脊柱畸形指数；骨折年龄、水平、类型和半定量严重程度分级（1-4 级）、术前磁共振成像（MRI）上是否存在椎体内裂隙和/或皮质破坏，以及骨水泥的粘度。在治疗水平的直接术后计算机断层扫描（CT）上评估水泥渗漏。除了一般的水泥渗漏外，还区分了三种基本不同的渗漏类型（皮质、硬膜外和前静脉），它们具有不同的可能临床后果，并评估了它们各自的危险因素。
在 173 个治疗的 OVCFs 中有 130 个（75.1%）检测到水泥渗漏。发现渗漏发生率随严重程度分级的增加呈近似线性增加。高骨折半定量严重程度分级（每级调整后的相对风险[RR]，1.14；95%置信区间[CI]，1.05-1.24；p=.002）和低骨水泥粘度（中 vs. 低粘度：调整后的 RR，0.73；95%CI，0.61-0.87；p<.001）是水泥渗漏的强烈危险因素。对于皮质渗漏（在 95%的椎间盘内渗漏中），MRI 上存在皮质破坏（调整后的 RR，1.62；95%CI，1.16-2.26；p=.004）和 MRI 上存在椎体内裂隙（调整后的 RR，1.43；95%CI，1.07-1.77；p=.017）被确定为另外两个强烈的危险因素。
高骨折严重程度分级和低粘度的聚甲基丙烯酸甲酯骨水泥是水泥渗漏的一般、强烈和独立的危险因素。使用 MRI 评估，皮质破坏和椎体内裂隙的存在被确定为皮质（椎间盘内）水泥渗漏的另外两个强烈危险因素，从而增加了预测能力。
