Impact On Postoperative Therapeutic Effects Of Cement Leakage In Percutaneous Vertebroplasty

Background and objectives: The prevalence of osteoporotic vertebra compression fracture(OVCF)and metastatic spine tumor is rising steadily with the aging of the population.As an effective and economical minimally invasive technique,Percutaneous Vertebroplasty,known as PVP,is popular in recent years.The most common complication of PVP is the cement leakage during the operating procedure.Though most patients don't have any symptoms,the cement leakage results in several fatal consequences.However,the mechanism remain unclear and the opinions differ from one surgeon to another.So the author carried out this thesis to research the relationships between cement leakage and therapeutic effects.Methods: A retrospective study was carried out to collect the information of patients who experienced percutaneous vertebroplasty,PVP,or percutaneous kyphoplasty in Department of Spine,Zhongda Hospital Affiliated to Southeast University in the period from Sep.2016 to Aug.2017.The X-ray,CT and MRI images were collected together with the VAS and ODI at the time point of preoperative,1-day-postoperative,3-day-postoperative,1-month-postoperative and 3-month-operative.Cases were separated into non-leakage and other 6 different leakage groups according their postoperative X-ray and CT.Results: 308 cases accord with the including and excluding criteria were taken into the research with an average age of 72.5±10.26 years,47 men and 261 women,256 PVP and 52 PKP.The amount of cement injected was 6.7±2.4 mL on average.There were 150 with cement leakages and 158 without.Type I paravertebral leakage counts 46(30.7%);Type II intraspinal leakage counts 3(16%);intervertebral foramen leakage counts 3(2%);disc leakage counts 19(12.7%);vein leakage counts 36(24%)and multiple leakage counts 22(14.6%).On the first postoperative,the VAS and ODI were significantly higher in the Type IV group than that of Control with a P less than 0.05.The Type IV and Type III leakage have a tendency towards a worse score than Control on Day 3.While all the difference has no statistical significance after a month and the KA show no difference eventually.Conclusion: Cement leakage is a common complication while different types of leakage have different prognosis.Some clinical decision should be made when facing with specific types of leakage.For Type II and V,they will cause fatal complications such as paraplegia and pulmonary embolism.Type IV leakage causes pain in near postoperative days but it has no impact on long-term pain relief.It increases the risk of intervertebral disc degeneration and adjacent vertebra fractures.