Cement injection and postoperative vertebral fractures during vertebroplasty
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(2019) 14:228
RESEARCH ARTICLE
Open Access
Cement injection and postoperative vertebral fractures during vertebroplasty Le Hu1,2†, Hao Sun1,2,3†, Hua Wang1,2, Jun Cai1,2, Yuping Tao1,2, Xinmin Feng1,2 and Yongxiang Wang1,2*
Abstract Objective: Vertebroplasty is the most widely used method for treating osteoporotic vertebral compression fractures (OVCF). During this procedure, bone cement is injected into the vertebral body. Fracture and additional fractures can occur adjacent to the treatment site. Thus, we studied factors causing such vertebral fractures after vertebroplasty and calculated the appropriate amount of bone cement to inject. Methods: From September 2012 to March 2016, 187 patients with OVCF undergoing vertebroplasty were selected, and 112 patients with complete follow-up information were selected. Of these, 28 had adjacent vertebral fractures (refracture group) during the follow-up period, and 84 patients had no adjacent vertebral fractures (control group). Then, sex, age, body weight, bone mineral density (BMD), and bone cement injection (bone cement injection volume and bone fracture vertebral volume percent) were compared. Results: All patients had significant pain relief within 24 h (preoperative and postoperative [24 h later] VAS scores were 7.4 ± 0.8 and 2.3 ± 0.5, respectively). The age and weight were not statistically significantly different (P > 0.05). BMD values were statistically significantly different between groups as was sex (P < 0.05). Conclusions: Bone cement injection volume, BMD values, and sex were statistically significantly related to adjacent vertebral fractures after vertebroplasty, and cement injection volumes exceeding 40.5% caused adjacent vertebral fractures. Keywords: Osteoporotic vertebral compression fractures (OVCF), Percutaneous vertebroplasty, Bone cement injection rate, Adjacent vertebral fractures
Introduction As the population ages, osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. It reduces the quality of life, impairs physical function, and increases mortality. Thus, the optimized treatment of OVCF is desired [1]. Vertebroplasty is an effective therapy for OVCF, and it reduces pain and prevents an additional collapse of the vertebral body via injection of bone cement into the fracture to fix the fractured vertebral body. However, some patients have immediate postoperative fractures of the adjacent vertebral body, and
this is undesirable [2–5]. It is likely that the distribution of cement and the injection volume cause vertebral stiffness, which can cause refractures [6, 7]. Current data suggest that bone cement injection volume and pain relief were positively correlated, so cement volumes exceeding the vertebral body volume were used for 27.8% of treated patients [8]. However, we now know that excessive bone cement volumes can increase the risk of bone cement leakage and increase vertebral body stiffness, causing adjacent vertebral fractures [7, 9]. Therefore, the
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