title: Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors.
abstract: METHODS
  Retrospective assessment of risk factors using univariate and multivariate analyses.
  
  
  OBJECTIVE
  To evaluate risk factors retrospectively for cement leakage (CL), including vascular cement leakage (vCL) and cortical cement leakage (cCL), in percutaneous vertebroplasty of spinal metastasis.
  
  
  BACKGROUND
  Complications of vertebroplasty for spine metastasis are rare but related to extravertebral cement leakage that is pulmonary embolism and medullary compression. Better understanding of the risk factors for vascular and cortical types of cement leakage is necessary to prevent these complications.
  
  
  METHODS
  Fifty-six cancer patients (30 females, 26 males; age, 56 ± 12 yr) (81 vertebrae) were treated in 58 sessions under fluoroscopy or computed tomography-fluoroscopy guidance. Leakage rates were reported. The following items were assessed for occurrence of CL, vCL, and cCL: primary tumor site, prior radiotherapy or local tumor ablation or embolization, appearance on computed tomography, cortical osteolytic destruction, vertebral collapse, operator's experience, guidance modality, and cement filling.
  
  
  RESULTS
  CL, vCL, and cCL rates were 53%, 25%, and 32%. History of prior treatment correlated with a decrease in CL (P = 0.018). vCL decreased when lung was the primary tumor site (P = 0.036), in osteolytic vertebrae (P = 0.033) or when there was a vertebral collapse (P = 0.037). cCL correlated with operator's experience (P = 0.021) and vertebral collapse (P < 0.001). Superior discal cCL correlated with superior endplate cortical destruction (P = 0.012). Although history of prior treatment seemed to be an independent protective factor (odds ratio = 0.24; 95% confidence interval, 0.087-0.7; P = 0.001), vertebral collapse was isolated as a risk factor for cCL (odds ratio = 32; 95% confidence interval, 6.7-161; P = 0.001).
  
  
  CONCLUSIONS
  Risk factors for cCL and vCL are distinct. Vertebral collapse and cortical destruction are risk factors for cCL. History of prior treatment is a protective factor for CL.
  
  
  METHODS
  4.
authors.affiliation: Departments of *Interventional Radiology and †Biostatistics, Institut Gustave Roussy, Villejuif, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Corcos
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dbjay
authors.forename: Charles
authors.initials: C
authors.lastname: Mastier
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leon
authors.forename: Anne
authors.initials: A
authors.lastname: Auperin
authors.forename: Thierry
authors.initials: T
authors.lastname: De Baere
authors.forename: Frédéric
authors.initials: F
authors.lastname: Deschamps
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D054854:Vertebroplasty / Q000009:adverse effects / Q000379:methods*
chemical_list: D001843:Bone Cements