The outcomes and complications of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures

English Keywords:Vertebroplasty  Cement leakage  Vertebral fracture  Osteoporosis  Bone cement

English Abstract:

  【Abstract】 Objectives: To compare the clinical outcomes and complications of high-viscosity and low-viscosity bone cement in percutaneous vertebroplasty(PVP) for osteoporotic vertebral compression fractures(OVCF). Methods： From September 2008 to February 2011, 60 patients with OVCF were enrolled in this study. The patients were randomized into the high-viscosity group(high-viscosity bone cement, 30 patients) and the low-viscosity group(low-viscosity bone cement, 30 patients). High-viscosity group used the PALACOS R+G high-viscosity PMMA, low-viscosity group used the MENDEC Spine low-viscosity PMMA. There was no significant difference in age, gender, BMI or the number of segments between the two groups(P>0.05). Clinical outcomes were assessed in terms of back pain visual analogue scale(VAS) and Oswestry disability index(ODI) after surgery. The outcomes of back pain VAS score, ODI, venous leakage rate, discoidal leak rate, rate of around vertebral body, rate of contiguous vertebral fracture were compared between two groups. Results： The mean follow-up in high and low-viscosity group was 3.7±0.9(range 2-5 years) and 3.7±1.0 years(range 2-5 years), respectively. There was no significantly different in the mean follow-up in both groups(P>0.05). The average VAS score and ODI improved significantly at final follow-up(P<0.05), from 8.4±1.4 to 0.5±0.7 and from (59.7±18.0)% to (8.1±5.6)% in low and high-viscosity group respectively. The average VAS score and ODI scale improved significantly at final follow-up(P<0.05), from 8.3±1.5 to 0.9±0.9 and from (67.7±12.5)% to (8.7±7.6)% in high and low-viscosity group respectively. At final follow-up, there was no significant difference in VAS or ODI in both groups(P>0.05). The venous leakage rate in the high-viscosity group was significantly lower than that in the low-viscosity group(8.2% vs.1.3%, P<0.05). The discoidal leak rate, paravertebral leak rate and rate of contiguous vertebral fracture in the high-viscosity group was 6.1%, 8.2% and 6.6%, respectively, while in the low-viscosity group it was 13.0%, 12.0% and 3.3%, respectively. There was no significant difference in discoidal leak rate, paravertebral leak rate or rate of contiguous vertebral fracture in both groups(P>0.05). Conclusions: The high-viscosity bone cement in PVP for osteoporotic vertebral fractures provides similar outcomes, discoidal leak rate, paravertebral leak rate and rate of contiguous vertebra fracture to low-viscosity bone cement, with a lower venous leakage rate.