Prediction of early vascular cement leakage following percutaneous vertebroplasty in spine metastases: the Peking University First Hospital Score (PUFHS)

Abstract

Background Cement leakage into venous blood posed significant challenge to surgeons. The aim of the study was to create a Peking University First Hospital Score (PUFHS) which could evaluate the probability of vascular cement leakage among spine metastases patients following percutaneous vertebroplasty. Methods The study retrospectively enrolled 272 spine metastases patients treated with percutaneous vertebroplasty. We randomly extracted all enrolled patients as the training or validation group and baseline characteristic comparison was assessed between the two groups. Creation of the PUFHS was performed in the training group and validation of the PUFHS was performed in the validation group. Results Of all the 272 patients, the total number of included vertebrae was 632 and the median treated levels were 2 per patient. Vascular cement leakage occurred in 26.47% (72/272) of patients. The baseline characteristics were comparable between the two groups (P > 0.05). Three risk predictors (primary cancer types, number of treated vertebrae levels, and vertebrae collapse) were included in the PUFHS. The area under the receiver operating characteristic curve (AUROC) of the PUFHS was 0.71 in the training group and 0.69 in the validation group. The corresponding correct classification rates were 73.0 and 70.1%, respectively. The calibration slope was 0.78 (95% confidence interval[CI]: 0.45–1.10) in the training group and 1.10 (95% CI: 0.73–1.46) in the validation group. The corresponding intercepts were 0.06 (95% CI: − 0.04–0.17) and − 0.0079 (95% CI: − 0.11–0.092), respectively. Conclusions Vascular cement leakage is common among spine metastases after percutaneous vertebroplasty. The PUFHS can calculate the probability of vascular cement leakage, which can be a useful tool to inform surgeons about vascular cement leakage risk in advance.

Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment

“…The anterior and posterior walls of the vertebral body are frequently destroyed by invasive spinal metastases. Therefore, cement leakage often occurs after using PMMA cement for spinal reconstruction, including cortical cement leakage and vascular cement leakage, 131 which is associated with risks of mechanical damage to the anterior aorta and posterior spinal cord of the vertebral body. 132,133 Cement leakage is responsible for the procedure's location and needle approach.…”