ObjectiveTo investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). MethodsBetween March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. ResultsAll procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. ConclusionThe volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.
ObjectiveTo investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. MethodsBetween August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. ResultsThe operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). ConclusionIn order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.