Risk factors for bone cement leakage in percutaneous vertebroplasty and its prevention

Abstract

Objectives: To analyze the risk factors for bone cement leakage during percutaneous vertebroplasty (PVP) and establish a predictive model to guide clinical prevention.

Methodology: This retrospective study analyzed 120 patients with osteoporotic vertebral compression fractures (OVCF) who underwent PVP  between June 2018 to June 2022. Based on postoperative imaging, patients were divided into leakage group (72 vertebral bodies) and non-leakage group (84 vertebral bodies). Univariate and multivariate logistic regression analyses were performed on 15 clinical and radiographic variables. The predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: This study included 120 patients, including 69 males and 51 females, with a mean age of 70.97 ± 5.04 years (range: 62–83 years),the analysis unit was the vertebral body, as some patients underwent multi-level PVP procedures, with the involvement of 156 vertebral bodies totally, 72 vertebral bodies had bone cement leakage and 84 vertebral bodies had no leakage, with a total leakage rate of 46.15% (72/156). Bone density (OR=4.953, P=0.001), cortical defect (OR=3.494, P=0.005), and bone cement injection volume (OR=2.885, P=0.016) were identified as independent risk factors for cement leakage. The combined predictive model incorporating these three factors demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) of 0.774 (P<0.001).

Conclusion: Low bone density, presence of cortical defects, and excessive cement volume independently increase leakage risk during PVP. Preoperative assessment and individualized cement injection strategies based on these factors may help reduce complication rates.