Abstract
The impact of cement leakage during percutaneous vertebroplasty has not been well characterized. This study aimed to quantify and compare cement leakage and its clinical significance in osteoporotic and metastatic vertebrae treated with vertebroplasty. Cement leakage was quantified using semi-automated thresholding of digital CT scans for fouteen metastatic and nineteen osteoporotic vertebrae and compared to pain scores. Cement leakage was present in 90.9% of vertebrae. Cement leaked predominantly into the disc in the osteoporotic vertebrae but yielded more diffuse leakage patterns in the metastatic cases. Despite cement leakage, there was significant improvement in pain immediately following vertebroplasty for all patients.
This study aimed to quantify cement leakage in osteoporotic and metastatic vertebrae post-vertebroplasty and to determine whether leakage has clinical significance at follow-up.
Despite high incidences of cement leakage, both osteoporotic and metastatic patients experienced significant immediate pain relief post-vertebroplasty.
Cement leakage is investigated as a possible rationale for the higher rates of pain relief seen in osteoporotic vs metastatic patients undergoing percutaneous vertebroplasty.
Cement leakage was present in 90.9% of the vertebrae treated. The percent volume of cement leakage was 11.6±10.6 in the osteoporotic vertebrae and 19.4±19.1 in the metastatic vertebrae (p=0.144). Cement leaked predominantly into the disc in the osteoporotic vertebrae whereas leakage was more diffuse in the metastatic vertebrae. Pain scores were high prior to vertebroplasty and decreased significantly following the procedure in both groups irrespective of leakage (p< 0.05).
Digital CT scans were retrieved for osteoporotic (n=19) and metastatic (n=14) patients treated with percutaneous vertebroplasty. Volume of cement injected directly into the vertebral body and location of cement leakage (pedicle, disc, periphery, canal) was quantified using semi-automated thresholding techniques. Pain scores were collected at four stages of treatment (pre, immediately post, one day post, one week post-vertebroplasty).
Disruption of the endplate in the osteoporotic spine provides an easily accessible pathway for the leakage of cement into the disc. Elevated pressurization during cement injection into metastatically involved vertebrae may account for the more diffuse cement leakage seen in the metastatic group. Clinically, pain scores improved irrespective of leakage.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
