Analysis of intradiscal cement leakage during percutaneous vertebroplasty: multivariate study of risk factors emphasizing preoperative MR findings.
OBJECTIVE
Previous reports have shown that intradiscal cement leakage during percutaneous vertebroplasty (PVP) is related to several risk factors. The purpose of this study was to evaluate preoperative MRI scans for such risk factors.


METHODS
The study retrospectively analyzed 136 patients (aged 43-93 years; 234 vertebral bodies) with osteoporotic compression fractures. All patients underwent both MRI and PVP. There were 28 men (20.59%) and 108 women (79.41%). Age, gender, bone mineral density (BMD) score, endplate cortical disruption, abnormal T2-weighted hyperintensity in adjacent discs, presence of Kümmell's disease, linear body fracture with extension to endplate, level of treated vertebral body and injected cement volume were considered risk factors for intradiscal cement leakage.


RESULTS
Of the 234 vertebral bodies, 55 bodies from 42 patients with no endplate cortical disruption showed no adjacent intradiscal cement leakage. Of 179 bodies from 95 patients with endplate cortical disruption, 54 (30.17%) showed intradiscal cement leakage. Of the other possible risk factors, abnormal T2 hyperintensity in adjacent discs was significantly related to intradiscal cement leakage (P = 0.016). The other possible factors (age, gender, BMD score, Kümmell's disease, linear body fracture extending to the endplate, level of treated vertebral body and injected cement volume) were not related to intradiscal cement leakage.


CONCLUSIONS
There was no adjacent intradiscal cement leakage without endplate cortical disruption. Abnormal T2 hyperintensity in adjacent discs may be related to intradiscal cement leakage, but only in the presence of endplate cortical disruption. Also, not having Kümmell's disease did not prevent intradiscal cement leakage. Thus, given these circumstances, careful cement injection is needed to reduce intradiscal cement leakage.
Department of Radiology, Korea University Guro Hospital, 152-703 Seoul, Republic of Korea.
Suk-Joo
SJ
Hong
Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-gu, 133-792 Seoul, Republic of Korea. Electronic address: radsh@hanyang.ac.kr.
Seunghun
S
Lee
Department of Rehabilitation Medicine, Korea University Guro Hospital, 152-703 Seoul, Republic of Korea.
Joon Shik
JS
Yoon
Department of Neurosurgery, Korea University Guro Hospital, 152-703 Seoul, Republic of Korea.
Ju Han
JH
Kim
Department of Neurosurgery, Korea University Guro Hospital, 152-703 Seoul, Republic of Korea.
Youn-Kwan
YK
Park
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use*; D015984:Causality; D015897:Comorbidity; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007403:Intervertebral Disc / Q000473:pathology*; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D012307:Risk Factors; D017678:Sex Distribution; D054854:Vertebroplasty / Q000706:statistics & numerical data*
D001843:Bone Cements
Bone cement; MRI; Spine; Vertebroplasty