Effects of bone cement distribution on the outcome of percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the elderly
Liu Xiaolei1, Zhang Jinbiao2, Sun Zhongyi3, Yu Xiao1, Jiang Qiting2, Tian Jiwei3, Wang Haibin1
1Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210032,China; 2Department of Orthopedics,the Affiliated Nanjing Jiangbei Hospital of Nantong University,Nanjing 210048,China; 3Department of Orthopedics,BenQ Hospital affiliated to Nanjing Medical University, Nanjing 210005, China
Abstract：Objective This study aimed to investigate the effects of bone cement distribution on the outcome of percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) in the elderly. Methods The retrospective cohort study was conducted. A total of 218 patients with single-segment OVCFs were included in the fourth affiliated hospital of Nanjing Medical University from December 2018 to December 2020, including 100 male and 118 female with an average age of (72.6±4.1)years (range, 65-79 years). All included patients underwent PVP, and they were divided into the well distributed group (105 cases) and poorly distributed group (113 cases) based on the distribution of bone cement by X-ray examination at postoperative 1 day. (1) The age, gender, time from injury to operation, body mass index (BMI), and other baseline data of the two groups were compared. (2) The operation time, volume of bone cement injected, and bone cement leakage were compared between the two groups. (3) The visual analogue scale (VAS) scores, Oswestry disability index (ODI), Cobb angle, anterior vertebral height (AVH), posterior vertebral height (PVH) of the 2 groups were compared 1 day after surgery and 1 year after surgery. Changes in bone mineral density, adjacent vertebral fractures, reloss of vertebral height and residual pain 1 year after surgery.The bone mineral density, adjacent vertebral fracture, vertebral height loss, and residual pain at postoperative 1 year were compared between the two groups. Results (1) No statistically significant difference in age, gender, time from injury to operation, BMI, and other baseline data was observed between the two groups (all P values >0.05). (2) All the 218 patients were successfully operated without spinal nerve injury and other complications. Moreover, no significant differences in operation time, volume of bone cement injected, and bone cement leakage were found between the two groups (all P values >0.05). (3) All 218 patients were followed up for 1 year. Three cases of adjacent vertebral fracture, eight cases of vertebral height loss, and six cases of residual pain were identified in the well distributed group, whereas 11 cases of adjacent vertebral fracture, 20 cases of vertebral height loss, and 18 cases of residual pain were identified in the poorly distributed group. The incidence of adjacent vertebral fracture, vertebral height loss, and residual pain in the well distributed group were all lower than those in the poorly distributed group with statistical differences between the two groups (χ2=4.28,4.94,5.80; all P values <0.05).Intra-group comparison: Compared with preoperative results, VAS score, ODI, and Cobb angle were decreased, whereas AVH and PVH were increased in the two groups at postoperative 1 day with statistical significances (all P values <0.001). Compared with day 1 after surgery, VAS score, ODI, Cobb angle, AVH and PVH in well distributed group 1 year after surgery were not significantly different (all P values >0.05). In the poorly distributed group, VAS score, ODI and Cobb angle increased 1 year after surgery, while AVH and PVH decreased, with statistical significance (all P values < 0.001). Comparison between groups: Comparison between the two groups showed no significant differences in VAS score, ODI, Cobb angle, AVH, and PVH before at postoperative 1 day (all P values >0.05). VAS score, ODI and Cobb angle of well distributed group were lower than those of poorly distributed group, while AVH and PVH of well distributed group were higher than those of poorly distributed group, with statistical significance (all P values <0.05). There was no significant difference in bone mineral density before and 1 year after surgery between the two groups (P=0.528,0.783). Conclusion Patients with single-segment OVCFs treated with PVP with good distribution of bone cement can reduce the risk of vertebral height loss, residual pain, and adjacent vertebral fracture.
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Liu Xiaolei, Zhang Jinbiao, Sun Zhongyi, Yu Xiao, Jiang Qiting, Tian Jiwei, Wang Haibin. Effects of bone cement distribution on the outcome of percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the elderly. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 301-307.
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2023, Vol. 28 
