J Korean Fract Soc.  2011 Oct;24(4):361-366.

Cement Leakage into Disc after Kyphoplasty: Does It Increases the Risk of New Adjacent Vertebral Fractures?

• Sohn HS
• Shin SK
• Seo ES
• Chang KS

Abstract

PURPOSE
This study aims to investigate the relationship between cement leakage into the disc during percutaneous balloon kyphoplasty and subsequent compression fractures in adjacent vertebrae during treatment of osteoporotic vertebral compression fracture.
MATERIALS AND METHODS
103 patients (118 vertebrae) who have been treated with balloon kyphoplasty due to osteoporotic compression fracture from June 2007 to July 2010 were retrospectively analyzed. The group was composed of 13 males and 90 females. The mean age was 75 years (57~95 years). The mean follow-up period was 10 months (6~30 months). Patients were divided into two groups; one with cement leakage into the disc and the other without cement leakage into the disc. The study was performed to determine whether subsequent compression fractures in adjacent vertebrae were related to several factors.
RESULTS
The cement leakages into the disc occurred in 16 of 118 vertebrae. Of the 16 vertebrae with cement leakage into the disc, 5 (31%) had subsequent adjacent vertebral compression fractures; however, of the 102 vertebrae in which cement leakage did not occur, only 11 (11%) had subsequent adjacent vertebral compression fractures (p<0.05). Of the 16 vertebrae with cement leakage into the disc, subsequent adjacent vertebral compression fractures occurred 1 vertebrae of 10 vertebrae with definite trauma history. Out of the 6 vertebrae with cement leakage and no definite trauma history, 4 vertebrae (67%) had subsequent adjacent vertebral compression fractures (p<0.05).
CONCLUSION
The cement leakage into the disc significantly increases the incidence of subsequent adjacent vertebral compression fractures. Most of the subsequent fractures occurred in the early post-operative period. When cement leakage into the disc occurred in patients with no definite trauma history such as slip down, the incidence of subsequent adjacent vertebral compression fracture increased significantly.

Keyword

Compression fracture; Cement leakage; Subsequent fracture; Kyphoplasty

MeSH Terms

Female
Follow-Up Studies
Fractures, Compression
Humans
Incidence
Kyphoplasty
Male
Retrospective Studies
Spine

Figure

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  Fig. 1 Distribution of the initial fractures by location.

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  Fig. 2 Distribution of subsequent fracture by time period.

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  Fig. 3 A 69 year-old woman with compression fracture of L1. Plain radiograph (A), (B) shows L1 osteoporotic vertebral compression fracture. Plain radiograph (C), (D) immediately after kyphoplasty of L1 shows cement leakage into T12-L1 intervertebral disc. Plain radiograph (E) and (F) 6 months after kyphoplasty shows subsequent fracture in lower end-plate of T12.

Reference

1. Baroud G, Nemes J, Heini P, Steffen T. Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J. 2003. 12:421–426.

2. Becker S, Meissner J, Tuschel A, Chavanne A, Ogon M. Cement leakage into the posterior spinal canal during balloon kyphoplasty: a case report. J Orthop Surg (Hong Kong). 2007. 15:222–225.

3. Belkoff SM, Jasper LE, Stevens SS. An ex vivo evaluation of an inflatable bone tamp used to reduce fractures within vertebral bodies under load. Spine (Phila Pa 1976). 2002. 27:1640–1643.

4. Chen WJ, Kao YH, Yang SC, Yu SW, Tu YK, Chung KC. Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech. 2010. 23:35–39.

5. Cortet B, Cotten A, Boutry N, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999. 26:2222–2228.

6. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J. 2008. 8:488–497.

7. Fribourg D, Tang C, Sra P, Delamarter R, Bae H. Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976). 2004. 29:2270–2276.

8. Jun DS, Shin WJ, Koh YH, Moon SH. MR predictors of bone cement leakage in percutaneous vertebroplasty and kyphoplasty for painful osteoporotic vertebral compression fracture. J Korean Soc Spine Surg. 2006. 13:184–190.

9. Kim MH, Min SH, Jeon SH. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. J Korean Fract Soc. 2007. 20:260–265.

10. Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol. 2004. 45:440–445.

11. Lee IJ, Choi AL, Yie MY, et al. CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty. Acta Radiol. 2010. 51:649–654.

12. Lee JH, Hwang DW, Shin JH, Hong WS, Kim JW. Factors confluencing the result of percutaneous balloon kyphoplasty in osteoporotic thoracolumbar compression fracture. J Korean Fract Soc. 2007. 20:76–82.

13. Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2001. 26:1631–1638.

14. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004. 25:175–180.

15. Lin WC, Cheng TT, Lee YC, et al. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol. 2008. 19:225–231.

16. Lo YP, Chen WJ, Chen LH, Lai PL. New vertebral fracture after vertebroplasty. J Trauma. 2008. 65:1439–1445.

17. Noonan PT. Disk-space PMMA leakage during vertebroplasty: a predictor of significant pain relief, 02-O-665-ASNR. 2002.

18. Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976). 2003. 28:991–996.

19. Ren H, Shen Y, Zhang YZ, et al. Correlative factor analysis on the complications resulting from cement leakage after percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. J Spinal Disord Tech. 2010. 23:e9–e15.

20. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003. 226:119–124.

21. Yu SW, Yang SC, Kao YH, Yen CY, Tu YK, Chen LH. Clinical evaluation of vertebroplasty for multiple-level osteoporotic spinal compression fracture in the elderly. Arch Orthop Trauma Surg. 2008. 128:97–101.