Risk Factors for Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: Retrospective study. OBJECTIVE: To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) using low-viscosity bone cement for osteoporotic vertebral compression fractures (OVCFs). SUMMARY OF BACKGROUND DATA: Cement leakage is the most common complication for PVP and its risk factors have been discussed. However, data in previous series were heterogeneous. Additionally, relative smaller patient sample or more types of cement leakage classified in those studies made the results conflicting. METHODS: A total of 1090 patients who underwent PVP with low-viscosity bone cement for OVCFs in 1456 levels between January 2016 and June 2019 were retrospectively reviewed. Parameters potentially affecting the occurrence of cement leakage were assessed using univariate and multivariate analyses. Cement leakage was assessed using postoperative computed tomography scanning, and classified into two types (cortical leakage and venous leakage) considering the mechanism. RESULTS: The incidence of cortical and venous leakage were 20.3% (295/1456) and 56.2% (819/1456), respectively. Cortical disruption, basivertebral foramen were the strongest risk factors for cortical leakage (P = 0.000), venous leakage (P = 0.000), respectively. Greater cement volume is one risk factor for both cortical leakage and venous leakage. The intravertebral cleft, solid type of cement distribution were significant risk factors for cortical leakage, and they both were protective factors for venous leakage. For cortical leakage, older age and trauma were another two risk factors. For venous leakage, female was another one risk factor, and higher grade of fracture severity is the strongest protective factor. CONCLUSION: Both cortical leakage and venous leakage are prevalent. Adequate known of risk factors could help balance the incidence of two type leakage in unique vertebra and reduce the incidence of leakage in general in PVP for OVCFs.Level of Evidence: 3.