Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty

Li, Mi; Zhang, Tao; Zhang, Rui; Zhang, Hanjun; Zhang, Dapeng; Hu, Naiwu; Wang, Yansong

doi:10.1016/j.wneu.2022.12.117

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…While PKP was designed to reduce the incidence of cement leakage observed in PVP, [4] instances of cement leakage still occur in PKP. [28][29][30] Whether VBS could decrease the incidence of cement leakage is controversial. Werner et al [16] found no significant advantage of VBS over PKP with regard to cement leakage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Zhang,

Peng,

2023

Jt Dis Relat Surg

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Objectives The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral compression fractures (OVCFs) and evaluate the clinical efficacy, Cobb angle correction, and cement leakage associated with both methods for OVCFs. Patients and methods A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Medline, China National Knowledge, and Wanfang Data for clinical studies comparing VBS with PKP for OVCF up to May 2023. The meta-analysis was performed using Review Manager 5.3, with a focus on evaluating clinical and radiologic outcomes. Results A total of eight eligible clinical studies were included in this meta-analysis. In terms of clinical outcomes, VBS was found to have a longer surgical time compared to PKP (standard mean difference [SMD]=1.06 min; 95% confidence interval [CI]: 0.20, 1.92; p=0.02). However, VBS demonstrated comparable blood loss to PKP (SMD =0.00 mL; 95% CI: –0.45, 0.45; p=0.99). Additionally, VBS showed slight superiority in alleviating back pain as measured by the Visual Analog Scale (VAS) (SMD=–0.38; 95% CI: –0.63, –0.12; p=0.004), as well as in improving functional disability based on the Oswestry Disability Index (ODI) (SMD= –0.28; 95% CI: –0.54, –0.03; p=0.03). Radiographically, VBS achieved better Cobb angle correction compared to PKP (SMD= –1.00; 95% CI: –1.48, –0.51; p<0.0001), while there was no significant difference in cement leakage between VBS and PKP (odds ratio=0.81; 95% CI: 0.21, 3.14; p=0.76). Conclusion The findings suggest that VBS has a comparable clinical outcome to PKP based on operation time, intraoperative blood loss, VAS, and ODI. Furthermore, VBS showed slightly better maintenance of Cobb angle correction, whereas VBS did not demonstrate a significant advantage over PKP in terms of cement leakage.

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Zhang,

Peng,

2023

Jt Dis Relat Surg

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“…As the APV technique is less affected by gravity, it is less prone to CL than the PVP group. Several factors can contribute to CL, including the injection method, the volume of cement injected, the severity of bone defects, and the cement properties [35,36]. In clinical practice, apart from using high-viscosity bone cement, vertebrogram, or high-resolution fluoroscopy, the APV technique can be considered [37,38].…”

Section: Discussionmentioning

confidence: 99%

Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution—An Ex Vivo Study in Goat Vertebrae

Lin

Tsuei

et al. 2023

Bioengineering

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Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats’ ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.

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“…In earlier research, factors including fracture patterns, surgical technique, injury duration, and cement viscosity were identified to be factors affecting cement leakage [13][14][15]. Moreover, a range of surgical techniques and devices has emerged to mitigate leakage risks [16]. Notably, vertebroplasty employing high-viscosity cement has gained traction as an increasingly utilized solution for managing osteoporotic compression fractures.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty

Cheng,

Chou,

Tsuei

et al. 2024

JCM

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Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced “aspiration percutaneous kyphoplasty”, also known as “decompressed kyphoplasty”, as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.

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Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty

Cited by 8 publications

References 32 publications

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution—An Ex Vivo Study in Goat Vertebrae

Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty

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