Affiliation:
1. University of Colorado, Aurora, Colorado
Abstract
Background: The most widely researched risk/complication following vertebroplasty (VP) or
kyphoplasty (KP) is that of adjacent level fracture (ALF). Current literature results regarding the
effect of intradiscal extravasation of cement on the risk of ALF is conflicting with about half
of the studies concluding there is no added risk with endplate extravasation and half of the
studies reporting opposite conclusions.
Objective: The purpose of the study is to further stratify the data to determine whether
specifically the location and extent of endplate cement extravasation more strongly affect ALF
risk in osteoporotic patients following either VP or balloon KP.
Study Design: Retrospective cohort study.
Setting: University teaching hospital
Methods: One hundred and fifty-six cemented levels in 80 patients, treated at a single
center between 2008 and 2012 were reviewed. Age, gender, T-score, body mass index, and
osteoporosis type (primary or secondary) were recorded. An ALF was defined as a fracture:
1) in a non-cemented vertebra; 2) adjacent to a cemented level; and 3) not due to trauma or
malignancy. Location of the cement extravasation (anterior, middle, or posterior third of the
vertebral body) and extravasation extent (percentage of the intervertebral disc height occupied
by the bolus) were measured. A logistic modeling strategy permitted examining the association
between the location and extent of extravasation and the odds of ALF.
Results: ALF occurred in 14 of the 52 patients (27%) and 20 of the 98 levels (20.4%)
remaining after exclusions. Odds of ALF were 5.9 times higher (95% CI: 1.6 to 21.2, P = 0.008)
with extravasation when compared to no leakage. Odds of ALF in a given patient were 22.6
times higher (95% CI: 3.0 to 170.9, P = 0.003) with anterior extravasation when compared
to no leakage. Leakage in the middle or posterior thirds and extent of extravasation were not
associated with ALF.
Limitations: Limitations of the study include the retrospective study design and small sample
size as well as the retrospective implementation of follow-up criteria posing risk of selection
bias.
Conclusions: Cement endplate extravasation isolated to the anterior third of the vertebral
body is associated with is significantly higher odds of ALF after VP or KP in patients with
osteoporosis.
Key words: Adjacent vertebral fracture, intradiscal leak, osteoporotic compression
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
10 articles.
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