OBJECTIVETo explore incidence rate, influencing factors, leakage routes,and preventative measures of bone cement leakages in vertebral internal reinforcement operation including percutaneous vertebroplasty and percutaneous kyphoplasty.

METHODSFrom January 2010 to January 2012,94 patients with osteoporotic vertebral compressive fracture,vertebral metastases and vertebral hemangioma were treated by vertebral internal reinforcement operation. Among them, there were 39 males and 55 females aged 55 to 86 with an average of 69.4 years old. The reasons, types, incidence and complications of bone cement leakage were analyzed.

RESULTSTotally 21 patients (26 vertebral) occurred bone cement leakage, the main routes included basivertebral veins, and bone cortex, which mainly located on adjacent intervertebrae and around vertebral body, and most of them were asymptomatic leakage. For the treatment of OVCFs, incidence of bone cement leakage in PKP was lower than that of PVP (P < 0.05), while incidince of PVP in treating vertebral metastases was worse than in treating OVCFs (P < 0.05).

CONCLUSIONBone cement leakage is a common complication in PVP and PKP. Careful analysis before operation, cautiously monitors and grasp operation indication in operation can decrease incidence of it.

Aged ; Aged, 80 and over ; Animals ; Bone Cements ; adverse effects ; China ; epidemiology ; Female ; Fractures, Compression ; surgery ; Humans ; Incidence ; Kyphoplasty ; adverse effects ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Postoperative Complications ; epidemiology ; etiology ; Spinal Fractures ; surgery ; Vertebroplasty ; adverse effects

BACKGROUND: Vertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted. METHODS: Forty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state. RESULTS: VAS was improved in the study group from 8.4 +/- 0.8 to 5.2 +/- 1.4, 6.4 +/- 1.2, 5.5 +/- 2.7, and 3.7 +/- 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 +/- 1.2 to 3.2 +/- 1.1, 3.2 +/- 1.7, 3.2 +/- 2.7, and 2.5 +/- 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9degrees +/- 8.0degrees to 15.2degrees +/- 6.1degrees (p = 0.046) and in the control group from 14.7degrees +/- 5.2degrees to 10.3degrees +/- 4.7degrees (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8degrees +/- 11.7degrees to 14.3degrees +/- 9.6degrees (p = 0.015). Correction angle was 2.7degrees +/- 4.6degrees, -7.9degrees +/- 5.3degrees, -7.2degrees +/- 5.2degrees, and -7.4degrees +/- 6.3degrees at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3degrees +/- 3.7degrees, 0.7degrees +/- 3.6degrees, 0.7degrees +/- 4.2degrees, and 0.1degrees +/- 4.4degrees, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5.250). CONCLUSIONS: In treatment of osteoporotic vertebral fracture, fresh frozen allogeneic bone chips are not recommendable as a filler for its worse results than bone cement.
Aged ; Bone Cements/adverse effects ; Bone Substitutes/adverse effects ; Case-Control Studies ; Female ; Humans ; Male ; Osteoporotic Fractures/epidemiology/*surgery ; Pain Measurement ; Transplantation, Homologous/adverse effects/instrumentation/*methods ; Vertebroplasty/adverse effects/instrumentation/*methods