[Prevention and treatment of bone cement leakage in percutaneous kyphoplasty for osteoporotic vertebral body compression fracture].
OBJECTIVE
To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fracture (OVCF).


METHODS
From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old (average 67.7 years old). All the patients suffered from trauma and the course of disease was 1-14 days (average 5.7 days). There were 159 compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case. The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement (average 4.8 mL) was injected into single vertebral body.


RESULTS
The operation time was 30-90 minutes (average 48 minutes). Obvious pain relief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed. Fourteen vertebral bodies had bone cement leakage (4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage). The reason for the bone cement leakage included the individuality of patient, the standardization of manipulation and the time of injecting bone cement. During the follow-up period of 12-30 months (average 24 months), all the patients got their normal life back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other complications.


CONCLUSIONS
For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain relief and stabilization of spinal stability. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.
Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, PR China.
Lei
L
Zhao
Liming
L
Wang
Gangrui
G
Wang
Jie
J
Xu
Yiwen
Y
Zeng
Shengnai
S
Zheng
Chunzhi
C
Jiang
Jianchao
J
Gui
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control*; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements