Search

Purpose: Percutaneous vertebroplasty (PVP) is a common procedure in spine surgery. Bone cement leakage is the most common complication related to this procedure. The purpose of this study was to assess the incidence and risk factors for cement leakage after PVP., Methods: A total of 485 patients who underwent PVP between August 2003 and August 2013 were enrolled in the study. Clinical and radiological characteristics, including age, gender, diagnosis, operated level, surgical approach, type of anesthesia, volume of bone cement, fracture type, and fracture severity, were considered as potential risk factors. Cement leakage was assessed based on post-operative imaging examination. Six types of leakage were defined and risk factors for each type were analyzed., Results: The incidence of leakage was 58.2 %. Binary logistic analysis revealed that larger volume of bone cement (P < 0.001) and higher fracture severity grade (P < 0.001) were the strongest independent risk factors. Univariate analysis and multinomial logistic analysis showed that surgical approach (P < 0.001), gender (P = 0.016), and operated level (P = 0.032) were additional risk factors for leakage. Further analysis showed that more bone cement was used in bilateral than unilateral approaches, that men had larger volumes of bone cement injected than women, and that more bone cement was injected into lumbar vertebrae than thoracic vertebrae. Therefore, these risk factors (surgical approach, gender, and operated level) could be attributed to excess bone cement usage., Conclusions: Cement leakage is very common with PVP. Higher fracture severity grade and larger volume of bone cement were the two strongest independent risk factors for leakage.

Purpose: This study evaluated the risk factors of new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PVP)., Methods: From June 2005 to January 2011, patients with osteoporotic VCFs (OVCFs) who were treated with PVP and met this study's inclusion criteria were retrospectively reviewed. Observed parameters were age, sex, bone mineral density, body mass index, amount of bone cement, cement leakage into the disk, preoperative kyphosis, preoperative degree of anterior vertebral compression, preoperative degree of middle vertebral compression, kyphosis correction, anterior vertebral height restoration, middle vertebral height restoration, and number of initial symptomatic fractures (levels treated). The data were analyzed by univariate and multivariate analysis for the emergence of new fractures after PVP to determine related risk factors., Results: A total of 182 patients met the inclusion criteria. There were 155 female and 27 male patients with a mean age of 69.7 years (range 49-91 years). The follow-up period was 24-50 months (average 26.4 months). A total of 294 VCFs among 182 patients were observed, 28 new VCFs occurred in 21 patients (21/182, 11.5 %) during the follow-up period. Statistical analysis indicated that higher BMI (P = 0.004) and a greater number of initial symptomatic fractures (P = 0.017) were significantly associated with new VCFs after PVP. It is the most obvious that the risk of new fractures increased 2.518-fold (95 % CI 1.176-5.395), when the number of initial VCFs increased by one level., Conclusions: The incidence of new symptomatic VCFs after PVP was higher in osteoporotic patients with initial multiple-level fractures.

Objective: To study the risk factors of secondary kyphotic angle increment after bone cement vertebroplasty for osteoporotic vertebral compression fractures., Methods: From October 2005 to May 2006, 32 (45 vertebrae) bone cement vertebroplasty procedures were performed. The operation time, injected cement volume, bone mineral density, visual analog scale (VAS) pain score, vertebral height, and kyphotic angle were recorded. The secondary increment of the kyphotic angle was calculated, and correlation analysis and linear regression analysis were performed., Results: The bone mineral density, the postoperative kyphotic angle and the vertebral midline height were significantly correlated to the secondary increment of the kyphotic angle., Conclusion: Large postoperative kyphotic angle, poor postoperative recovery of the vertebral midline height, and low bone mineral density are all risk factors of secondary increment of the kyphotic angle.

Objective: To test the efficacy of kyphoplasty using an enhanced balloon expander in restoring the height of vertebral compression fractures (OVCF)., Methods: Fifteen lumbar vertebral bodies (L1-L5) were harvested from 3 young male fresh cadavers and separated into individual vertebral bodies with the bilateral pedicles of the vertebral arch removed. Before operation, plain X-ray films of all the vertebral bodies were obtained. All the vertebral bodies were compressed lengthwise to approximately 80% of their original heights using a universal material-testing machine to result in compression fractures. Post-compression vertebral bodies were then repaired using an enhanced balloon expander, and the delivery of the bone cement into the vertebral bodies was observed. The heights of the anterior and posterior borders of the vertebral bodied were measured before and after compression as well as after kyphoplasty., Results: The inflation of the balloon expander averaged 2.95-/+0.18 ml and the pressure was 122.67-/+27.89 psi (1 psi=6895 Pa). Kyphoplasty resulted in significant restoration of the vertebral body height lost due to the compression (P<0.01)., Conclusion: Kyphoplasty using an enhanced balloon expander may restore vertebral body height damaged by compression and correct the kyphotic deformity. The balloon expander can be a effective and economic choice for kyphoplasty for its relatively low cost.