Risk factors for cement leakage and nomogram for predicting the intradiscal cement leakage after the vertebra augmented surgery

Abstract

Background Vertebral augmentation is the first-line treatment for the osteoporosis vertebral compression fractures. Bone cement leakage is the most common complication of this surgery. This study aims to assess the risk factors for different types of cement leakage and provides a nomogram for predicting the cement intradiscal leakage. Methods We retrospectively reviewed 268 patients who underwent vertebral augmentation procedure between January 2015 and March 2019. The cement leakage risk factors were evaluated by univariate analysis. Different types of cement leakage risk factors were identified by the stepwise logistic analysis. We provided a nomogram for predicting the cement intradiscal leakage and used the concordance index to assess the prediction ability. Results A total of 295 levels of vertebrae were included, with a leakage rate of 32.5%. Univariate analysis showed delayed surgery and lower vertebral compression ratio were the independent risk factors of cement leakage. The stepwise logistic analysis revealed percutaneous vertebroplasty was a risk factor in vein cement leakage; delayed surgery, preoperative compression ratio, and upper endplate disruption were in intradiscal cement leakage; age, preoperative fracture severity, and intravertebral vacuum cleft were in perivertebral soft tissue cement leakage; no factor was in spinal canal cement leakage. The nomogram for intradiscal cement leakage had a precise prediction ability with an original concordance index of 0.75. Conclusions Delayed surgery and more vertebral compression increase the risk of cement leakage. Different types of cement leakage have different risk factors. We provided a nomogram for precise predicting the intradiscal cement leakage.

The relation of vertebral artery occlusion and intravertebral cleft: a prospective magnetic resonance angiography study

“…IVC formation in the osteoporosis vertebral compression fracture was signi cantly associated with the poor prognosis of the patients [1][2][3]. Therefore, the pathogenesis of the IVC received much attention.…”

“…However, the OVCF with intravertebral cleft (IVC) formation was always indicating a poor prognosis even after the vertebral augmentation surgery. Complications such as cement leakage [1], augmented vertebra recollapse (Fig. 1 f, g) [2], and the adjacent vertebral fracture [3] were more common in IVC patients.…”

“…Compression rate (CR) was calculated according to previous study [1]. Fracture severity was graded as grade 1: mild (<25% collapse); grade 2: moderate to severe (>25% collapse) [14].…”

A Nomogram to Predict Intra-Spinal Canal Cement Leakage Among Elderly Patients with Spine Metastases: An Internal-Validated Model

“…Recent studies reported the prevalence of intra-spinal canal cement leakage ranged from 2.70% to 13.58% among patients with osteoporotic vertebral fractures treated with PVP. 12 , 13 Intra-spinal canal cement leakage may lead to severe complications and even disability. Therefore, a risk model that can evaluate the risk of intra-spinal canal cement leakage was clinically essential.…”

Development and Validation of a Nomogram for Predicting the Probability of Adjacent Segmental Fractures After Vertebral Augmentation of Osteoporotic Vertebral Compression Fractures

“…New predictive models, including lasso regression and nomogram based on multiple logistic regression, have been developed and validated to predict postoperative vertebral compression fractures [12,13] . As far as we know, this is the first attempt to develop a nomogram-based method for adjacent vertebral fractures after vertebroplasty.…”