The correlation analysis of intradiscal cemment leakage and adjacent vertebral fracture after percutaneous vertebral augmentation

English Keywords:Osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Percutaneous kyphoplasty  Intradiscal cemment leakage  Adjacent vertebral fracture

English Abstract:

  【Abstract】 Objectives: To assess the correlation between intradiscal cemment leakage and adjacent vertebral fracture(AVF) after percutaneous vertebral augmentation(PVA), and further to determine the effects of cemment leakage location and volume into adjacent discs on AVF. Methods: A total of 151 patients with osteoporotic vertebral compression fracture(OVCF ), who were treated with PVA and followed up for 1 to 3 years, were rolled in this study. The followings were collected: gender, age, location of treated vertebral body, bone cement volume and surgical options. Whether or not intradiscal cemment leakage, leakage location(anterior, middle, or posterior of the adjacent disc), and relative area ratio of leakaged cemment-adjacent disc were evaluated on the post-operative X-ray of thoracic and lumbar spine. The correlations of the above factors and AVF were assessed. The risk factors of AVF were analyzed by using binary logistic regression model. Results: There were 192 vertebrae augmented in 151 cases, and intradiscal cemment leakage were found in 55 vertebrae. The incidence of AVF was 41.8% in intradiscal cemment leakage group and 20.4% in none intradiscal cemment leakage group(P=0.002). The relative area ratio of leakaged cemment-adjacent disc was (24.4±11)% in AVF group and (13.7±9.3)% in none AVF group(P<0.001). The area under the ROC curve of leakaged cemment-adjacent disc relative area ratio for occurrence of AVF was 0.807, with a cut-off value of 16.1%, and the sensitivity was 87.0% and the specificity was 72.2%. The age of AVF group was 75.8±7.8 years, larger than none AVF group 73.0±8.3 years(P=0.036). The incidence of AVF in bone cement volume <5ml and ≥5ml was 20.0% and 35.4% respectively, and the difference was statistically significant(P=0.017). The area under the ROC curve of bone cement volume for occurrence of AVF was 0.537 with a cut-off value of 5.25ml, and the sensitivity was 58.3% and the specificity was 63.9%. There was no statistically significant association of AVF and gender, location of treated vertebral body, surgical approach, location of cemment leakage(P>0.05). The results of binary logistic regression analysis showed that age and relative area ratio of leakaged cemment-adjacent disc were independent risk factors of AVF(P<0.05). Conclusions: Intradiscal cemment leakage is an important risk factor of AVF, which correlates positively with the cement leakage volume into adjacent disc. Reducing or avoiding the cement leakage into adjacent disc during PVA can reduce the risk of AVF. The relative area ratio of leakaged cemment-adjacent disc can predict AVF effectively, and can be an useful tool for evaluating the risk of AVF after PVA.