Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospective study

Abstract

BackgroundOsteoporotic vertebral compression fracture (OVCF) is a common type of fracture, and percutaneous kyphoplasty (PKP) is an eligible solution to it. Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes after PKP procedure. However, the role of bone cement distribution remains to be illustrated.MethodsTo retrospectively evaluate the relationship between the bone cement distribution and the clinical outcomes of unilateral PKP, we enrolled 73 OVCF patients receiving unilateral PKP treatment. All the intervened vertebrae were classified into three groups based on the bone cement distribution observed on postoperative X-ray films. Preoperative and postoperative radiographic parameters including the vertebral height and kyphotic Cobb angle were recorded, and anterior vertebral height restoration rate (AVHRR) and Cobb angle correction (CR) were then calculated to assess the vertebral height reconstruction. Preoperative and postoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) were adopted by interviewing patients to assess the mobility improvement and pain relief. Demographic data, body mass index (BMI), lumbar bone mineral density (evaluated by BMD T-score) of each patient, bone cement volume (BV), and bone cement extravasation (BE) were also recorded. Between- and within-group comparisons and multivariable correlation analysis were carried out to analyze the data.ResultsVAS and ODI scores were both significantly improved in all of the enrolled cases with no significant differences between groups. Among the three groups, the average age, AVHRR, and BV were significantly different. Occurrence of BE was significantly different between two of the three groups. AVHRR was demonstrated to correlate negatively with preoperative anterior vertebral height ratio and positively with preoperative Cobb angle, CR, diffusion score, and ODI changes.ConclusionsBone cement distribution is a potential predictor to the reconstructive effects in unilateral PKP for OVCFs. Bone cement distribution is associated with AVHRR and BV, as well as the risk of BE occurrence. Greater bone cement distribution may indicate better vertebral restoration along with a higher BE risk.

A novel and convenient method to evaluate bone cement distribution following percutaneous vertebral augmentation

“…The distribution of bone cement is known to affect the outcome and complications of vertebral augmentation [12][13][14][15][16][17][18][19][20][21][22] , but there is no recognized, convenient, effective method to assess such distribution or predict prognosis for patients undergoing vertebral augmentation. It would be particularly helpful if the method could assess distribution and predict outcome in real time to guide surgery.…”

“…In addition, cytotoxicity and heat generation of bone cement also play a role in pain relief of patients received vertebral augmentation [9][10][11] . The amount of bone cement used can influence risk of various complications after vertebral augmentation [12][13][14][15][16][17][18][19][20][21] . Injection of excessive bone cement tends to induce new fractures of adjacent vertebral bodies and may increase the leakage rate [12][13][14][15] , while too little bone cement can result in insufficient filling, which can fail to relieve the pain rapidly 15,16 and easily induce re-collapse of the treated vertebrae [17][18][19] .…”

“…The amount of bone cement used can influence risk of various complications after vertebral augmentation [12][13][14][15][16][17][18][19][20][21] . Injection of excessive bone cement tends to induce new fractures of adjacent vertebral bodies and may increase the leakage rate [12][13][14][15] , while too little bone cement can result in insufficient filling, which can fail to relieve the pain rapidly 15,16 and easily induce re-collapse of the treated vertebrae [17][18][19] . However, the amount of bone cement per se is unlikely to be the most reliable predictor of whether the cement will achieve a satisfactory distribution, given differences in vertebral body size as well as in location and degree of compression [14][15][16] .…”

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

“…Some literatures classi ed the bone cement distribution according to its diffusion on anteroposterior Xray lm, and then their in uence on the long-term outcome was studied [8]. However, this classi cation method was mostly applicable for unilateral puncture cases, because bilateral puncture injection of bone cement can often achieve a uniform distribution on both sides of the vertebral body, effectively avoiding the uneven stress caused by asymmetric distribution on the coronal plane.…”

“…There were 26 males and 111 females, with an average age of 69 ± 7.0 years old. The average follow-up time was 15.3 ± 6.3 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months.…”