Correlative Factor Analysis on the Complications Resulting From Cement Leakage After Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

Study Design The correlative factors for complications resulting from cement leakage were retrospectively reviewed in 71 patients who underwent percutaneous kyphoplasty. Objective To explore the correlative factors affecting the complications of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Summary of Background Data Over the past decade, percutaneous kyphoplasty has been increasingly used as treatment of choice for osteoporotic vertebral compression fractures. However, current literature contains less information about the correlative factors affecting the complications resulted from cement leakage. Methods In all, 71 patients with 171 vertebral compression fractures who were treated by percutaneous kyphoplasty in the department of spine surgery at our medical center were identified from the registry and were retrospectively reviewed. The treatment efficacy was determined by the assessment of change in vertebral body height, Cobb angle, visual analog scale and Oswestry functional score between preoperative, postoperative, and the latest follow-up. Complications were recorded and associated risk factors were determined and analyzed. Results All patients had immediate and significant improvement in back pain after being treated with percutaneous kyphoplasty. Cement leakage occurred in 17 (9.94%) out of 171 vertebral bodies, including 7 paravertebral leaks, 6 leaks into intervertebral space, 3 leaks into channel of needling insertion, and 1 spinal canal leak. Four patients (5.63%) developed pulmonary complications postoperatively, one of them with confirmed diagnosis of pulmonary embolism directly caused by cement leakage. During the follow-up, we found 9 recurrence vertebral fractures in 6 patients (8.45%), including 6 adjacent vertebral bodies. Univariate analysis revealed a significant difference in preoperative vertebral body height, injected cement volume, and vertebral body wall incompetence between the cement leakage group and no cement leakage group (P<0.05). In contrast, there is no significant difference in the preoperative Cobb angle, freshness of vertebral fracture, location of operative vertebrae, and operative approach between the 2 groups (P>0.05). Multiple logistic regression analysis showed that the injected cement volume and vertebral body wall incompetence were the predominant variables associated with the complications resulting from cement leakage. The patients who had a history of pulmonary diseases were prone to develop lung-related complications after the surgery. Conclusions The cement viscosity, injected cement volume, vertebral body wall incompetence, and a history of pulmonary diseases were the factors affecting the complications resulting from cement leakage. The recognition of these risk factors is helpful in efforts to improve surgical technique to reduce the risk of complications after being treated by percutaneous kyphoplasty.