Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients.

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.