The Relationship between Perivertebral Venous Cement Embolism and Balloon Expansion Pressure in Balloon Kyphoplasty

Abstract

Introduction: Osteoporotic vertebral compression fractures (OVCFs) are common fractures in the elderly suffering osteoporosis. Most patients have bone fusion with deformity of vertebral collapse; however, some patients suffer nonunion and persistent pain at the fracture site. Due to the limitations of conservative treatment, balloon kyphoplasty (BKP) has been recently performed for OVCFs. This study aimed to investigate the relationship between cement embolization and balloon expansion pressure (BEP) in patients who underwent BKP. Methods: We investigated 62 patients who underwent BKP for cement embolization into the perivertebral veins among the 155 patients admitted to our hospital due to thoracolumbar vertebral compression fractures between April 1, 2019, and March 31, 2020. Surgery was indicated for patients who had severe back or low back pain and whose daily life was severely impaired, and in whom the shape of the vertebral body was clearly changed on functional X-ray. Results: Intraoperative X-ray and postoperative CT revealed cement embolization into the perivertebral veins in three cases (4.83%). The BEP was significantly higher in the group with cement embolism than in the group without cement embolism (P < 0.001). Pulmonary cement embolism (PCE) and infection were not observed. One case of cement leakage into the spinal canal was observed (1.61%). Conclusions: While the surgical intervention of BKP can contribute to the treatment of OVCFs, careful attention should be paid to the prevention of complications, including cement embolization into the perivertebral veins, and such complications should be appropriately managed.

Analysis of Potential Risk Factors for Cement Leakage into Paraspinal Veins after Vertebroplasty for Acute Osteoporotic Vertebral Fractures Based on a 3D Reconstruction Technique: A Retrospective Matched Case–Control Study

“…Because of the high viscosity of the bone cement and low pressure in the early stage of injection, the cement easily disperses along the cavity, and the injection of an appropriate volume can ensure effective filling of the fracture line. 31 , 32 In addition, our results show that there may be a certain correlation between the puncture angle and PVL, with a smaller puncture angle potentially leading to PVL more easily, which is similar to the results reported by Liu et al 33 Compared with the fracture line distribution, the main fracture line length is more likely to be influenced by factors such as the timing and volume of cement injection, which is difficult to effectively address by adjusting the puncture direction and angle. Therefore, these findings also suggest that attention should be given to other factors in addition to examining the influence of the fracture line on PVL.…”

“…Therefore, these findings also suggest that attention should be given to other factors in addition to examining the influence of the fracture line on PVL. 31 , 32 , 33 …”

“…Therefore, these findings also suggest that attention should be given to other factors in addition to examining the influence of the fracture line on PVL. [31][32][33] With the advancement of technology, robot-assisted surgery has shown promising applications in spine surgery. 34 In 2021, Shi et al 34 applied the ZOEZEN robot for PVP in 30 patients with thoracolumbar fractures and achieved satisfactory clinical results.…”