Cement Leakage in Percutaneous Vertebroplasty for Spinal Metastases: A Retrospective Evaluation of Incidence and Risk Factors

Study Design. Retrospective assessment of risk factors using univariate and multivariate analyses. Objective. To evaluate risk factors retrospectively for cement leakage (CL), including vascular cement leakage (vCL) and cortical cement leakage (cCL), in percutaneous vertebroplasty of spinal metastasis. Summary of Background Data. Complications of vertebroplasty for spine metastasis are rare but related to extravertebral cement leakage that is pulmonary embolism and medullary compression. Better understanding of the risk factors for vascular and cortical types of cement leakage is necessary to prevent these complications. Methods. Fifty-six cancer patients (30 females, 26 males; age, 56 ± 12 yr) (81 vertebrae) were treated in 58 sessions under fluoroscopy or computed tomography–fluoroscopy guidance. Leakage rates were reported. The following items were assessed for occurrence of CL, vCL, and cCL: primary tumor site, prior radiotherapy or local tumor ablation or embolization, appearance on computed tomography, cortical osteolytic destruction, vertebral collapse, operator's experience, guidance modality, and cement filling. Results. CL, vCL, and cCL rates were 53%, 25%, and 32%. History of prior treatment correlated with a decrease in CL (P = 0.018). vCL decreased when lung was the primary tumor site (P = 0.036), in osteolytic vertebrae (P = 0.033) or when there was a vertebral collapse (P = 0.037). cCL correlated with operator's experience (P = 0.021) and vertebral collapse (P < 0.001). Superior discal cCL correlated with superior endplate cortical destruction (P = 0.012). Although history of prior treatment seemed to be an independent protective factor (odds ratio = 0.24; 95% confidence interval, 0.087–0.7; P = 0.001), vertebral collapse was isolated as a risk factor for cCL (odds ratio = 32; 95% confidence interval, 6.7–161; P = 0.001). Conclusion. Risk factors for cCL and vCL are distinct. Vertebral collapse and cortical destruction are risk factors for cCL. History of prior treatment is a protective factor for CL. Level of Evidence: 4

[1]  D. Kang,et al.  The Analysis of Patterns and Risk Factors of Newly Developed Vertebral Compression Fractures after Percutaneous Vertebroplasty , 2012, Journal of Korean Neurosurgical Society.

[2]  M. Reiser,et al.  CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients , 2012, Skeletal Radiology.

[3]  A. V. van Erkel,et al.  Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. , 2011, The spine journal : official journal of the North American Spine Society.

[4]  R. Edwards,et al.  Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. , 2011, Clinical radiology.

[5]  Y. Saida,et al.  Therapeutic effects of percutaneous vertebroplasty for vertebral metastases , 2011, Japanese Journal of Radiology.

[6]  A. V. van Erkel,et al.  A Clinical Comparative Study on Low Versus Medium Viscosity PolyMethylMetAcrylate Bone Cement in Percutaneous Vertebroplasty: Viscosity Associated With Cement Leakage , 2010, Spine.

[7]  J. Yoon,et al.  CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty , 2010, Acta radiologica.

[8]  G. Paradot,et al.  Percutaneous vertebroplasty for pain management in malignant fractures of the spine with epidural involvement. , 2010, Radiology.

[9]  Wen-Jer Chen,et al.  Impact of Cement Leakage Into Disks on the Development of Adjacent Vertebral Compression Fractures , 2010, Journal of spinal disorders & techniques.

[10]  T. López-Cuadrado,et al.  Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis , 2009, BMC palliative care.

[11]  D. Kallmes,et al.  Clinical Outcomes with Hemivertebral Filling during Percutaneous Vertebroplasty , 2009, American Journal of Neuroradiology.

[12]  D. Regge,et al.  Percutaneous Vertebroplasty and Bone Cement Leakage: Clinical Experience with a New High-Viscosity Bone Cement and Delivery System for Vertebral Augmentation in Benign and Malignant Compression Fractures , 2008, CardioVascular and Interventional Radiology.

[13]  Nico Verdonschot,et al.  The Influence of Endplate-to-Endplate Cement Augmentation on Vertebral Strength and Stiffness in Vertebroplasty , 2007, Spine.

[14]  A. Hiwatashi,et al.  Cement leakage during vertebroplasty can be predicted on preoperative MRI. , 2007, AJR. American journal of roentgenology.

[15]  J. Chiras,et al.  Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty. , 2007, AJNR. American journal of neuroradiology.

[16]  Gamal Baroud,et al.  High-Viscosity Cement Significantly Enhances Uniformity of Cement Filling in Vertebroplasty: An Experimental Model and Study on Cement Leakage , 2006, Spine.

[17]  Y. Barzilay,et al.  Cement Leakage in Percutaneous Vertebroplasty: Effect of Preinjection Gelfoam Embolization , 2006, Spine.

[18]  J. Chiras,et al.  Percutaneous vertebroplasty for spinal metastases: complications. , 2006, Radiology.

[19]  Cari M Whyne,et al.  Biomechanical assessment of stability in the metastatic spine following percutaneous vertebroplasty: effects of cement distribution patterns and volume. , 2005, Journal of biomechanics.

[20]  A. J. Zeller,et al.  Percutaneous vertebroplasty for malignant compression fractures with epidural involvement. , 2004, Radiology.

[21]  Sean Molloy,et al.  The Effect of Vertebral Body Percentage Fill on Mechanical Behavior During Percutaneous Vertebroplasty , 2003, Spine.

[22]  C. Whyne,et al.  A Biomechanical Analysis of Intravertebral Pressures During Vertebroplasty of Cadaveric Spines With and Without Simulated Metastases , 2003, Spine.

[23]  A. Gangi,et al.  Percutaneous Vertebroplasty: Indications, Technique, and Results , 2002 .

[24]  K. Ahrar,et al.  Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients , 2003 .

[25]  K. Lange,et al.  Preoperative and postoperative cognitive functioning in patients with frontal meningiomas. , 2003, Journal of neurosurgery.

[26]  C. K. Lee,et al.  Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. , 2003, The Journal of bone and joint surgery. British volume.

[27]  N. Beauchamp,et al.  Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutives procedures. , 2002, AJNR. American journal of neuroradiology.

[28]  P. Heini,et al.  Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results , 2000, European Spine Journal.

[29]  H. Deramond,et al.  Percutaneous vertebroplasty in benign and malignant disease. , 2000 .

[30]  R. Assaker,et al.  Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. , 1996, Radiology.

[31]  J. Chiras,et al.  Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. , 1996, Radiology.

[32]  DAVID A. WONG,et al.  Spinal Metastases: The Obvious, the Occult, and the Impostors , 1990, Spine.

[33]  H. Deramond,et al.  [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. , 1987, Neuro-Chirurgie.