Comparison of Cement Leakage Rate and Severity After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures Using Front-Opening Versus Side-Opening Cannulas.

The authors assessed the occurrence and severity of cement leakage (CL) following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) performed using front-opening cannulas (FOCs) vs side-opening cannulas (SOCs). This retrospective cohort study included 811 patients with single-level OVCFs who underwent PVP between March 2016 and September 2018. The 264 patients who met the inclusion criteria were divided into two groups according to whether the procedure was performed using a FOC (n=128) or a SOC (n=136). Visual analog scale score, Oswestry Disability Index, local kyphotic angle, vertebral height, amount of bone cement injected, and rate of CL were compared between the groups. Types of CL were classified according to postoperative computed tomography. The CL types were further classified according to severity (mild and severe). Visual analog scale score, Oswestry Disability Index, local kyphotic angle, and vertebral height were all significantly improved after surgery. The total incidence of CL was significantly higher for FOCs than for SOCs (P=.001). Similarly, the occurrence of the CL subtypes was significantly higher for FOCs than for SOCs (B type, P=.033; C type, P=.01; and S type, P=.015). Analysis of CL type severity revealed that the rates of severe D type (intradiskal leakage category of the C type) and severe S type were significantly lower for SOCs than for FOCs (P=.001), while the incidence of severe B type leaks was not significantly different between the groups (P=.443). Percutaneous vertebroplasty performed using SOCs decreases the incidence and severity of D type and S type CL compared with FOCs. Secondary classification of CL could help physicians better understand the severity of leakage and select a more appropriate surgical approach to reduce CL. [Orthopedics. 2021;44(3):134-140.].

Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study.

OBJECTIVE: To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). METHODS: This retrospective matched-cohort study included patients 50-90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). RESULT: Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. CONCLUSIONS: Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.