Risk Factors for Cement Leakage After Vertebroplasty or Kyphoplasty: A Meta-Analysis of Published Evidence

Zhan, Yongli; Jiang, Jianzhong; Liao, Haifen; Tan, Hua-Qiao; Yang, Keqin

doi:10.1016/j.wneu.2017.01.124

Cited by 156 publications

(138 citation statements)

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“…Although kyphoplasty is an effective surgical treatment for an immediate reduction of pain and deformity that can accompany vertebral compression fractures, in certain cases, however, defects or clefts in the vertebral body may cause the cement leakage into the epidural space, paraspinal soft tissues, or disc space [5,6]. These cement materials, typically consisting of polymethyl methacrylate (PMMA) which offers mechanical stability, becomes a problem when the leakages of unreacted PMMA monomer liquid before cement polymerization in the bone bed occurred, which may cause remote organ embolism or local chemical or compress symptoms and even the thermal injury [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

et al. 2019

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Kyphoplasty is an important treatment for stabilizing spine fractures due to osteoporosis. However, leakage of polymethyl-methacrylate (PMMA) bone cement during this procedure into the spinal canal has been reported to cause many adverse effects. In this study, we prepared an implantable membrane to serve as a barrier that avoids PMMA cement leakage during kyphoplasty procedures through a hybrid composite made of poly-l-lactic acid (PLLA) and tricalcium silicate (C 3 S), with the addition of C 3 S into PLLA matrix, showing enhanced mechanical and anti-degradation properties while keeping good cytocompatibility when compared to PLLA alone and most importantly, when this material design was applied under standardized PMMA cement injection conditions, no posterior wall leakage was observed after the kyphoplasty procedure in pig lumbar vertebral bone models. Testing results assess its effectiveness for clinical practice.2 of 17 the created cavity after balloon inflation during the kyphoplasty procedure [10]. Following which the balloon is re-inserted and inflated, creating a cement shell or a cement membrane around the inner walls of the created cavity, and another batch of cement was mixed and injected into the remaining cavity thereafter with limited cement leakage possibility from initial cement setting. Although this double cement application with PMMA as the cement anti-leakage shell or membrane has demonstrated its efficacy in clinical trial during the kyphoplasty procedure [11], the long term complications might be devastating due to PMMA presence on the bone cement surface [9], which makes the development of a new material design for anti-leakage membrane necessary. For example, Tetsushi Taguchi et al. had fabricated the reactive poly(vinyl alcohol) (PVA) membrane for the prevention of bone cement leakage with good potential for implantable balloon kyphoplasty, but further investigations on its clinical efficiency are still in progress [12].On the other hand, polymeric membranes fabricated from a single material more often have limited biological performance compared to the use of hybrid biomaterials composed of biodegradable synthetic polymers and inorganic materials, with the hybrid biomaterials fitting better to bone tissue engineering applications due to their similar compositions to natural bones [13,14]. For example, biodegradable polymers such as poly(L-lactic acid) (PLLA) (L-lactic acid isomer of polylactic acid (PLA), an aliphatic thermoplastic polyester obtained by polymerizing lactide monomers) have been used for scaffold design doped with dicalcium silicate (C 2 S) nanoparticles as an ideal candidate for novel bone graft substitutes with enhanced mechanical and biodegradable properties, and biointeractive nature [15,16]. Scaffolds fabricated from (PLLA)/dicalcium phosphate dihydrate (DCPD) composite by indirect casting had also shown to effectively improve the mechanical strength and biocompatibility for the repair of bone defects when compared to the scaffold from neat PLLA [17]. From which the h...

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Section: Introductionmentioning

confidence: 99%

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

et al. 2019

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“…The most common complication of PVP is bone cement leakage. It is easy for the bone cement to leak : P = 0.001 vs. VAS score at 1 day after the operation c : P = 0.05 vs. VAS score at 1 day after the operation through the vertebral veins, fractured cracks, but causing clinical symptoms is less common [21]. The amount of bone cement injected was positively correlated with the occurrence of bone cement leakage [22].…”

Section: Discussionmentioning

confidence: 99%

The clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction in the treatment of Kümmell’s disease

Jiang

et al. 2020

BMC Musculoskelet Disord

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Background: Kümmell's disease is a special type of osteoporotic vertebral fracture that causes chronic low back pain and deformity, which seriously affects the living quality of patients. PVP is commonly used to treat osteoporotic vertebral fractures and can quickly relieve low back pain. So, the objective of this study was to analyze the clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction for the treatment of Kümmell's disease. Methods: A retrospective analysis of patients with Kümmell's disease who underwent bipedicular percutaneous vertebroplasty was conducted from February 2016 to May 2018. Operative time, VAS, bone cement injection volume, cement leakage rate, compression improvement of vertebral front edge and vertebral center, and correction degree of kyphosis were collected and analyzed meticulously. Results: The operative time was 45.33 ± 7.64 min. The volume of bone cement injected was 5.38 ± 1.33 ml. The compression improvement of vertebral front edge was 7.31 ± 1.21%. The compression improvement of vertebral center was 10.34 ± 1.15% and the correction degree of kyphosis was − 2.73 ± 0.31゜. Bone cement leakage occurred in 6 of 39 patients (15.38%), but no clinical symptoms were observed. The VAS scores were significantly lower at 1 day after the surgery, 6 months and at the last follow-up than before the surgery (P = 0.000, respectively). The VAS score was lower at the last follow-up than at 1 day after the surgery (P = 0.001). Conclusion: Bipedicular percutaneous vertebroplasty combined with postural reduction could achieve satisfactory analgesic effect in the treatment of Kümmell's disease, and restore the height of the vertebral body and improve kyphosis to some extent.

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“…It has already been demonstrated by several different studies that one of the reasons why kyphoplasty seems to be associated with lower rates of cement extravasation to endplates, epidural vessels and venous affluents of the inferior vena cava is the fact that the cement injection occurs at lower pressures once a cavity is created by the inflation of the balloon. In fact, it has been estimated that the injection pressure is reduced by more than threefold by the creation of a cavity in the vertebral body before cement injection (average maximum intravertebral pressure in the group with void creation versus the one without void creation of 1.20 vs 5.09 kPa, P = .001) …”

Section: Discussionmentioning

confidence: 99%

Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale

Mattei

Perret

2020

Clinical Case Reports

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Risk Factors for Cement Leakage After Vertebroplasty or Kyphoplasty: A Meta-Analysis of Published Evidence

Cited by 156 publications

References 50 publications

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

The clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction in the treatment of Kümmell’s disease

Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale

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