Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae.

Mousavi P, Roth S, Finkelstein J, Cheung G, Whyne C.

Orthopaedic Biomechanics Laboratory, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

OBJECT: The goal of this study was to quantify volumetrically cement fill and leakage in patients with osteoporotic and metastatic vertebral lesions undergoing percutaneous vertebroplasty and to establish whether these factors have any clinical significance at follow up.

METHODS: Digital computerized tomography data were retrospectively collected from all cases at the authors' institution in which percutaneous vertebroplasty was performed for osteoporosis or metastatic disease. Patient selection was based on the consensus of a multidisciplinary team consisting of an orthopedic surgeon, an oncologist, and a neuroradiologist. A semiautomated thresholding technique was used to measure vertebral body volume, the volume of cement injected directly into the vertebra, and the volume of cement leakage. Pain-related scores were collected at four early stages of treatment, and all clinical complications were recorded.

Cement leakage was found in 87.9% of vertebrae treated with percutaneous vertebroplasty. In osteoporotic vertebrae it occurred mainly in the disc, whereas in metastatic lesions, it was found in multiple areas. Irrespective of leakage, both patients with osteoporotic and metastatic disease experienced significant immediate pain relief postoperatively.

CONCLUSIONS: Although there was no correlation between cement fill or cement leakage and pain relief, there exists a risk of serious complications due to cement leakage.