Incidence, Risk Factors, and Outcomes of Symptomatic Bone Cement Displacement following Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Single Center Study

Abstract

Study design: Retrospective. Background: Symptomatic bone cement displacement (BCD) is a rare complication following percutaneous kyphoplasty (PKP) interventions for osteoporotic vertebral compression fracture (OVCF). This study aimed to investigate the incidence and the outcomes of symptomatic BCD comprehensively and identify its risk factors. Methods: The clinical data of patients treated with PKP for OVCF between January 2012 and December 2020 were extracted. Patients who developed BCD following PKP during follow-up were divided into the symptomatic and asymptomatic groups. Patients who did not develop BCD were assigned to the control group. Univariate and multiple logistic regression analyses were used to compare the three clinical groups’ features to assess the independent risk factors for the symptomatic and asymptomatic groups. Results: A total of 896 patients were enrolled. Twenty-one patients (2.3%) were identified as having symptomatic BCD following PKP for OVCF, and 35 (3.9%) developed asymptomatic BCD. Compared with the control group, the symptomatic and asymptomatic groups had a higher incidence of anterior leakage, intravertebral vacuum cleft (IVC) signs, and a lower cement distribution score. The symptomatic group had a lower relative cross-sectional area (rCSA) of the paraspinal muscle (PSM), higher PSM fatty degeneration, and higher kyphotic angle (at the last follow-up) than the asymptomatic and control groups. For outcomes, the symptomatic group had a higher VAS/ODI score and a higher incidence of new vertebral fractures compared with the asymptomatic and control groups. Anterior leakage (OR: 1.737, 95% CI: 1.215–3.300), the IVC sign (OR: 3.361, 95% CI: 1.605–13.036), the cement distribution score (OR: 0.476, 95% CI: 0.225–0.904), PSM rCSA (OR: 0.953, 95% CI: 0.917–0.992), and PSM fatty degeneration (OR: 1.061, 95% CI: 1.005–1.119) were identified as independent risk factors for the symptomatic group. Anterior leakage (OR: 1.839, 95% CI: 1.206–2.803), the IVC sign (OR: 2.936, 95% CI: 1.174–9.018), and cement distribution score (OR: 0.632, 95% CI: 0.295–0.858) were independent risk factors for the asymptomatic group. Conclusion: The incidence of symptomatic BCD is 2.3% in patients treated with PKP. Anterior leakage, the IVC sign, and the distribution score were independent risk factors for BCD, and paraspinal muscle degeneration was a specific risk factor for symptomatic BCD. Symptomatic BCD can lead to poor outcomes.

Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty

“…This phenomenon might be more evident with the highviscosity cement, which has a poorer ability to penetrate into cancellous bone [34], causing a higher risk of intradiscal leakage. Uneven cement distribution may be linked to suboptimal cement integration, potentially resulting in cement displacement following the surgical procedure [35].…”

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

“…Previous clinical case reports have also shown displacement of bone cement, but our experimental results generally have a higher displacement rate ( Korovessis et al, 2013 ), perhaps due to the extreme smoothness of the cortical bone defect and the complete coverage of the cancellous bone surface by bone wax in our experimental models to better control the number of variables. The KD model designed in the experiment meets the clinical and radiographic characteristics of intravertebral cleft ( Formica et al, 2016 ; Qi J. et al, 2022 ). This makes it possible that the measured displacement of the bone cement in the experiment indicates the trend and magnitude of displacement.…”

“…KD presents with back pain without obvious causes or after minor trauma based on osteoporosis, followed by a long or short asymptomatic period. Eventually, prolonged spine pain reappears in the same area and cannot be relieved, leading to the development of kyphosis ( Qi J. et al, 2022 ; Li et al, 2023 ).…”

Comparison of percutaneous vertebroplasty and percutaneous vertebroplasty combined with pediculoplasty for Kümmell’s disease: a retrospective observational study

“…Recently, with the widespread use of vertebroplasty, bone cement loosening has rarely been reported as one of the complications following vertebroplasty. According to previously published reports, the incidence of bone cement loosening (or even dislodgement) after vertebroplasty is estimated to be between 0.51 and 25% [ 9 – 11 ]. However, the precise mechanism underlying bone cement loosening remains elusive.…”