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Purpose The aim of this work was to investigate the risk factors for cement leakage and new-onset OVCF after Percutaneous vertebroplasty (PVP) and to develop and validate a clinical prediction model (Nomogram). Methods Patients with Osteoporotic VCF (OVCF) treated with PVP at Liuzhou People’s Hospital from June 2016 to June 2018 were reviewed and met the inclusion criteria. Relevant data affecting bone cement leakage and new onset of OVCF were collected. Predictors were screened using univariate and multi-factor logistic analysis to construct Nomogram and web calculators. The consistency of the prediction models was assessed using calibration plots, and their predictive power was assessed by tenfold cross-validation. Clinical value was assessed using Decision curve analysis (DCA) and clinical impact plots. Results Higher BMI was associated with lower bone mineral density (BMD). Higher BMI, lower BMD, multiple vertebral fractures, no previous anti-osteoporosis treatment, and steroid use were independent risk factors for new vertebral fractures. Cement injection volume, time to surgery, and multiple vertebral fractures were risk factors for cement leakage after PVP. The development and validation of the Nomogram also demonstrated the predictive ability and clinical value of the model. Conclusions The established Nomogram and web calculator (https://dr-lee.shinyapps.io/RefractureApp/) (https://dr-lee.shinyapps.io/LeakageApp/) can effectively predict the occurrence of cement leakage and new OVCF after PVP.

Background The impact of intravertebral cleft (IVC) on cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) has been discussed. However, the results were conflicting, as the study population and cement leakage classification were heterogeneous. The aim of the study was to evaluate the impact of IVC on the incidence of leakage through vein, leakage through cortex as well as general leakage in PVP for OVCFs. Methods All patients with OVCFs who underwent PVP between January 2016 and June 2019 at our institution were retrospectively reviewed. Patients were eligible for this case-control study if they were diagnosed as single level fracture in spine. After inclusive and exclusive criteria were met, a total of 139 patients with IVC were enrolled as the study group. Non-IVC controls were matched in a 1:1 ratio in age (within 3 years), sex and fracture severity with patients in study group. Cement leakage were classified into four types [type B (through basivertebral vein), type S (through segmental vein), type-C (through a cortical defect), and type D (intradiscal leakage)], furtherly into two types [venous type (type-B or/and type S) and cortical type (type-C or/and type-D)]. A general leakage rate and a specific leakage rate per each type were compared between both groups. Results Each group included 139 patients. Groups were homogenous for age, sex, fracture severity, fracture location, fracture type, cement volume, puncture approach and property of cement. Compared with control group, IVC group had a significantly lower rate of type-B (20.9% vs. 31.7%, P = 0.041), type-S (24.5% vs. 52.5%, P = 0.000), and venous type leakage (37.4% vs. 67.6%, P = 0.000), a significantly higher rate of type-C (25.9% vs. 12.2%, P = 0.004), type-D (16.5% vs. 6.5%, P = 0.009), and cortical type leakage (40.3% vs. 16.5%, P = 0.000), no significant difference on the rate of general leakage (67.6% vs. 76.3%, P = 0.109). Conclusion IVC decreased the risk of cement leakage through vein and increased the risk of cement leakage through cortex. However, it had no significant effect on the occurrence of general leakage.

Background Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. Case presentation An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. Conlcusions If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

Introduction/Objective. Several studies have evaluated anesthesia type as a possible risk factor for cement leakage in percutaneous vertebral augmentation procedures. This study has the largest series in the literature revealing data on the incidence of cement leakage in percutaneous kyphoplasty under sedoanalgesia. The aim of the study was evaluating the possible association between sedoanalgesia and cement leakage in percutaneous kyphoplasty procedures. Methods. In this study, 195 vertebral compression fractures treated with percutaneous kyphoplasty under sedoanalgesia in 165 patients were retrospectively reviewed. The association between sedoanalgesia and cement leakage in percutaneous kyphoplasty procedures was evaluated. Results. The mean age (years) of study population was 64.37 years (range 24?108 years), and the male? female ratio was 71/94. No significant difference in the proportion of males (n = 71, 43.03%) and females (n = 94, 56.96%) was observed between groups. Among the 195 fractured segments, most frequent fractures were observed at the T12 (n = 41, 21.02%) and L1 (n = 65, 33.33%) levels. Conclusion. Sedoanalgesia is not a risk factor for cement leakage in percutaneous kyphoplasty and offers a safe anesthesia option to avoid possible complications.

The purpose of this case report was to present successfully treated case of symptomatic cement leakage after percutaneous vertebroplasty procedure (PVP) with technical tips to avoid such injury and to present literature review. PVP is a simple solution to treat osteoporotic vertebral compression fracture (OVCF) if it is performed with right indications. Cement leak into spinal canal during PVP can lead to catastrophic accident and cause severe neurological deficit that requires an urgent exploration and removal of cement. To avoid medial pedicle breach, there should be a definitive guideline during PVP. An 81-year-old lady had PVP after injury for OVCF at D12. She developed severe neurological deficit immediately after the procedure; however, she was managed conservatively. On presentation to us, urgent investigations with CT scan revealed cement leak into spinal canal from medial pedicle breach extending from D10-12 level with severe cord compression. Her surgery was performed with wide laminectomy at D10-D12 levels with transpedicular stabilization D9-L2 along with neuromonitoring. Cement mass was isolated from the dura and removed achieving decompression of the cord. Postoperatively, patient showed significant neurological improvement and walked independently with the help of stick in three months. In conclusion, although PVP is a convenient solution for painful OVCF, care must be taken while considering this option such as timing, insertion of needle, viscosity of cement, and C-arm monitoring. If neurological deficit occurs, urgent CT scan for the diagnosis and exploration with removal of cement with or without stabilization is mandatory.

OBJECTIVE To compare the efficacy between hyperextension position (HPVP) and neutral position for vertebroplasty (NPVP) in treating Kummell disease. STUDY DESIGN A Comparative descriptive study. PLACE AND DURATION OF STUDY Department of Orthopaedics, Yantaishan Hospital, China, from December 2017 to July 2018. METHODOLOGY This study retrospectively analysed demographic features, operative information, radiologic data, and complications of 58 consecutive patients with single-level Kummel disease (KD) who underwent NPVP (n=27) or HPVP (n=31). All patients were observed preoperatively and at 2 days (POD 2) and one year postoperatively for cement leakage, Cobb's angle, antenior body height ratio, pain and disability. RESULTS The cement leakage rate was significantly lower in the HPVP group (p

Yan Ding,1,* Shengjie Dong,1,* Jingjie Wang,1 Jinpeng Cui,2 Zhilin Cao,1 Shiqiao Lv1 1Department of Orthopaedics, Yantaishan Hospital, Yantai 264000, People’s Republic of China; 2Clinical Laboratory, Yantaishan Hospital, Yantai 264000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shiqiao LvDepartment of Orthopaedics, Yantaishan Hospital, No. 91 Jiefang Road, Yantai 264000, People’s Republic of ChinaTel +86-13001612636Email 68402128@qq.comPurpose: This study aimed to compare the demographic features (including total cost), surgical effects, radiographic parameters, and complications of kyphoplasty (KP) and vertebroplasty (VP) in the hyperextension (HP) and neutral positions (NP) and to assess their efficacy and cost-effectiveness for treating single-level osteoporotic vertebral compression fractures (OVCF).Patients and Methods: This was a retrospective analysis of 245 consecutive patients who underwent KP or VP from February 2018 to February 2019 with observation on postoperative day 2 and at the one-year follow-up. The first 122 patients (86 KP and 36 VP cases) were treated in the neutral position, and the remaining 123 in the hyperextension position (90 VP and 33 KP cases). Back pain and impact on daily life were evaluated. Cobb’s angle and the ratio of the anterior (AR) and middle vertebral (MR) bodies were the main radiographic parameters. The chi-square test, one-way analysis of variance (ANOVA), repeated measurement ANOVA, and post hoc tests (Bonferroni adjustments) were used for statistical analysis.Results: There were no significant differences in the demographic features, operation time, or rate of re-fracture at the one-year follow-up among the groups. The rate of cement leakage was significantly lower in the HPVP group than in the NPKP group. The total cost was significantly lower in the VP groups than in the KP groups. At the one-year follow-up, back pain was significantly lower in the HPVP group than in the NPKP group. The Oswestry Disability Index, Cobb’s angle, AR, and MR in the HPVP group were similar to those in the NPKP and HPKP groups, but better than those in the NPVP group.Conclusion: HPVP can achieve better pain relief, and similar disability scores, Cobb’s angle, AR and MR recovery, with a lower total cost, compared with NPKP. HPVP is the most economically efficacious treatment for OVCF.Keywords: cement leakage, Cobb’s angle, kyphosis, surgical outcome, vertebral height

A systematic review and meta-analysis. The purpose of this study was to evaluate the clinical outcome and safety of sacroplasty for patients with secondary metastatic lesions to the sacrum. Several databases, including the Cochrane library, PubMed and EMBASE, were systematically searched to identify potentially eligible articles in English language. All the above databases were searched until December 2019. The search strategy was based on the combination of the following keywords: sacroplasty AND secondary tumours OR metastasis OR metastases. The reference list of the selected literature was also reviewed and a standard PRISMA template utilised. From a total of 102 articles initially identified, a final seven studies were identified as meeting the inclusion criteria. A total of 107 patients from these studies were included. The follow-up ranged from immediate post-operatively to 30.5 months. The mean preoperative VAS was 8.38 (range 6.9–9.3), which improved significantly to 3.01 (range 1.12–4.7) post-operatively (p

Purpose This study аims to explore cement leаkаge аs а complication of percutаneous vertebroplаsty (PVP) in the treаtment of multiple osteoporotic vertebrаl compression frаctures (MOVF). Patients and methods This prospective study wаs cаrried out on 32 consecutive pаtients with osteoporotic frаctures of аt leаst two vertebrаe (VB). Аll pаtients were over 50 yeаrs old аnd women аccounted for 29 out of the 32 pаtients (90.6%). PVP wаs performed under digitаl subtrаction аngiogrаphy (DSА) of аt leаst three VB, аnd 97 collаpsed VB аnd 105 VB were exаmined by PVP. Аll pаtients hаd postoperаtive computerized tomogrаphy (CT) to diаgnose аnd clаssify the complicаtions. Results One hundred аnd five vertebrаe were exаmined with PVP, аnd 36/105 (34.3%) exhibited complicаtions of cement leаkаge. Type B cement leаkаge wаs the most common complicаtion, with 19/105 (18.1%) cаses; type C аccounted for 8/105 (7.6%) cаses; аnd type S аccounted for 9/105 (8.6%) cаses. There wаs only one (0.95%) cаse of cement leаkаge moving to the pulmonаry аrtery. Аll complicаtions hаd no clinicаl symptoms аnd did not require treаtment. Conclusion Cement leаkаge is quite а common complicаtion, but it usuаlly hаs no clinicаl symptoms аnd does not require treаtment. Therefore, PVP is а sаfe аnd successful technique for the treаtment of multiple osteoporotic vertebrаl compression frаctures.

Purpose This study aims to develop an algorithm to predict cement injection volumes in patients with spine metastases treated with percutaneous vertebroplasty (PVP). Risk factors were also analyzed for intra-spinal canal cement leakages. Patients and Methods A retrospective analysis of 584 vertebrae in 251 patients. Patients and vertebrae were divided into three groups based on grades of tumor invasion to the spinal cord. Patients with the complete posterior wall of vertebrae were classified into group A, patients without the complete posterior wall of vertebrae but with normal Dural sac were classified into group B, and patients with deformation of the Dural sac but without neurological symptom were classified into group C. We systematically reviewed demographic data, clinical parameters, radiology features, and cement leakages among the three groups. The multiple linear regressions were used to screen potential risk factors and develop the algorithm to predict injected cement volumes in vertebrae. Significant factors were included in the algorithm. Potential risk factors for intra-spinal canal cement leakage were analyzed using the multiple logistic regressions. Results In the study, 17.1% (100/584) of vertebrae occurred cement leakages. Vertebrae in group C (28.6%, 8/28) had the highest cement leakage rate than patients in group A (14.4%, 61/424) and B (23.5%, 31/132) (P=0.014). Vertebrae in group C (14.3%, 4/28) were also more prone to intra-spinal canal leakages (P=0.003). The multiple logistic analysis showed that the Bilsky scale was significantly associated with intra-spinal canal cement leakages (P

Aim: Balloon kyphoplasty is a popular minimally invasive technique for vertebral fractures. Although vertebral fractures occur mostly in the thoracolumbar region, compression fractures can be seen in the entire vertebral column. The mid-thoracic levels are difficult areas in terms of complications in minimally invasive procedures. Our study aimed to examine the effect of balloon kyphoplasty on vertebral height, kyphosis angle, and cement leaks as a complication in mid-thoracic vertebral fractures.Materials and Methods: Radiological images, patient files, and pathology results of patients who underwent kyphoplasty due to a single or multiple mid-thoracic vertebral fractures between 2017 and 2020 were retrospectively analyzed.Results: A total of 19 patients (9 males and 10 females) and 28 operated vertebrae were included in the study. The mean age of the patients was 58.42±18.79 (23-86) years, and the mean operation time was 40.18±15.01 minutes (17-99). The amount of cement used during the procedures was 3.68±1.13 mL (1.5-7), and postoperative cement leakage was observed in 12 levels (42.9%). Anterior and median vertebral heights and kyphosis angle improved significantly compared to preoperative values (p, Amaç: Vertebra kırıklarında uygulanan perkütan balon kifoplasti yöntemi, popüler minimal invaziv bir tekniktir. Vertebra kırıkları çoğunlukla torakolomber bölgede meydana gelse de tüm vertebral kolonda kompresyon fraktürü görülebilir. Orta torakal seviyeler minimal invaziv işlemlerde komplikasyon açısından riskli bölgelerdendir. Çalışmamızda orta torakal vertebra kırıklarında uygulanan perkütan balon kifoplasti yönteminin vertebra yüksekliğine, kifoz açısına etkisini ve komplikasyonu olan sement kaçaklarını incelemeyi amaçladık.Gereç ve Yöntem: 2017-2020 yılları arasında tek ya da çoklu seviye orta torakal vertebra fraktürü nedeni ile kifoplasti uygulanan hastaların radyolojik görüntüleri, hasta dosyaları ve patoloji sonuçları retrospektif olarak incelendi.Bulgular: Çalışmaya toplamda 19 hasta (9 erkek ve 10 kadın) ve 28 işlem yapılan vertebra dâhil edildi. Hastaların yaş ortalaması 58.42 ± 18.79 (23-86) yıl olarak hesaplandı. Operasyon süresi 40,18 ± 15,01 dk (17-99) idi. İşlem sırasında kullanılan sement miktarı 3,68 ± 1,13 mL (1,5-7) idi. Postoperatif sement kaçağı 12 (%42,9) seviyede görüldü. Anterior ve median vertebra yükseklikleri ile kifoz açısı operasyon öncesine göre anlamlı ölçüde iyileşme gösterdi (p

Xuedong Shi,1,* Yunpeng Cui,1,* Yuanxing Pan,1 Bing Wang,1 Mingxing Lei2,3 1Department of Orthopedic Surgery, Peking University First Hospital, Beijing, 100032, People’s Republic of China; 2Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, People’s Republic of China; 3Chinese PLA Medical School, Beijing, 100853, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xuedong ShiDepartment of Orthopedic Surgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of ChinaTel +86 10-83572211Email 172998774@qq.com; xuedongs@hotmail.comMingxing LeiDepartment of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Jianglin Road, Haitang District, Sanya, 572013, People’s Republic of ChinaTel +86-18811772189Email 825979020@qq.comPurpose: This study aimed to assess the risk variables for predicting intra-spinal canal cement leakage, especially among elderly patients with spine metastases after being treated with percutaneous vertebroplasty (PVP). Furthermore, we proposed and validated a nomogram to stratify risks of intra-spinal canal cement leakage.Methods: We retrospectively analyzed 163 elderly patients (age ≧65 years) with spine metastases who underwent PVP. Patients were randomly divided into a training cohort (n=100) and a validation cohort (n=63). The multivariate logistic regression analysis was used to screen potential risk variables in the training cohort. Significant risk variables were included in the nomogram, and the nomogram was developed according to the estimates of the each included variable. The predictive effectiveness of the nomogram was validated using discrimination and calibration performance.Results: The overall prevalence of intra-spinal canal cement leakage was 9.82% (16/163). In the training cohort, female patients (14.71%, 5/34) showed a higher rate of intra-spinal canal cement leakage as compared with male patients (4.55%, 3/66). The nomogram consisted of sex, cortical osteolytic destruction in posterior wall, and load-bearing lines of spine. The nomogram had acceptable discrimination, with the area under the receiver operating characteristic (AUROC) of 0.75 in the training cohort, 0.64 in the validation cohort, and 0.69 in the entire cohort, and also showed favorable calibration based on the goodness-of-fit test. According to the nomogram, three risk groups were developed: the low risk group had an actual probability of 7.03%, the medium risk group was 11.54%, and high risk group was 44.44%. The difference between the three groups was significant (P ˂ 0.01).Conclusion: Intra-spinal canal cement leakage after PVP is not scarce among elderly patients. We proposed and internally validated a nomogram that is capable of calculating the risk of intra-spinal canal cement leakage among elderly patients with spine metastases. Careful surgical plan should be conducted among patients with a high risk of developing intra-spinal canal cement leakage.Keywords: elderly patients, spine metastases, percutaneous vertebroplasty, cement leakage, nomogram

Background: Percutaneous vertebroplasty (PV) has become an important minimally invasive surgical technique for vertebral compression fractures. However, indications for PV in these cases due to trauma had many rivals and unclearly. These complications, especially cement leakage still common, has many severe consequent. Object and method research: A 60-years-old man, who underwent vertebroplasty in low medical level. He had complete paralised of two leg, urine retention, and severe low back pain. We examined clinical signs, imaging, find and compared with literatures. Case presentation and discussion: We present a case, 60-years-old man, had labor accident, after that he could returned to state of normality. At the second day, he went to local hospital, had diagnosis: compression fractures of L1-L2. He underwent percutaneous vertebroplasty of L1-2 under local anesthesia. Post-operative, he had complete paralised of two leg, urine retention, and severe low back pain. He had exmined again, MRI and took second surgery to removed part of cement leakage. After the second surgery, radiological showed they had complete removed cement leakage, but the patient’s recovery was uneventful and stable. The patient was hospitalized at our instituation after 03 day with complaints of severe low back pain, urine retention and complete paralised of two leg. Conclusion: This is basic technique, widely and rewarding; also has many severe incident, complications. Consequently, we suggest that this technique have to perform in right indications, in the modern medical centre and fully trained surgeon.

Percutaneous vertebroplasty (PVP) was first reported in 1987 for treating vertebral hemangiomas. PVP is also an effective treatment for osteoporotic vertebral compression fracture that mainly involves a percutaneous injection of polymethylmethacrylate. Severe complications of PVP have been reported in recent years. However, to the best of our knowledge, cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after PVP has rarely been reported. We experienced a patient with cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after PVP. Fortunately, after conservative therapy, we achieved a satisfactory result. Unfortunately, we could not explain the cause of the cement leakage and formation of the thrombotic embolism. We believe that surgeons should have a better understanding of the fracture pattern and anatomy of the vertebral venous net system. They should also perform meticulous imaging monitoring with slower pushing of the cement to minimize the risks during the PVP. This case report highlights a rare, but potentially life-threatening, complication of PVP. Surgeons need to be aware of the possibility of cement leakage and the formation of cement-associated thrombotic embolism so that they are much more vigilant when performing PVP.

A 91-year-old woman presented with left lower extremity swelling and pain diagnosed as phlegmasia cerulea dolens. Doppler ultrasound and venography revealed extensive left lower extremity deep venous thrombosis. Review of prior images revealed cement leakage causing compression of the left common iliac vein. She underwent successful mechanical thrombectomy using the ClotTriever device (Inari Medical, Irvine, Calif) and subsequent stent placement. Phlegmasia cerulea dolens resolved on the following day, and the stent remained patent at the 1-month follow-up appointment. Cement leakage from L5 vertebroplasty can cause extrinsic compression on the left common iliac vein, resulting in iatrogenic venous compression syndrome and the development of deep venous thrombosis in the affected lower extremity. Keywords: Vertebroplasty, Cement leakage, Stenosis, Common iliac vein, Venous compression syndrome, Deep venous thrombosis

Objective. In this randomized, nonblinded, controlled study, the feasibility and precision of “targeted percutaneous vertebroplasty” (“targeted PVP”) for osteoporotic vertebral compression fracture (OVCF) was evaluated. Methods. A total of 42 patients, aged 50 to 87 years, with OVCF were randomly divided into 2 groups: A and B. Group A underwent “targeted PVP,” and group B underwent traditional PVP with the guidance of C-arm fluoroscopy. Fluoroscopy times for skin puncture points (FTSPP), total radiation doses (TRD), total fluoroscopy times (TFT), and operation time were set as the main evaluation indicators. Results. FTSPP (1.52 ± 0.51 in group A vs 6.62 ± 2.58 in group B, U < .001), TRD (6.26 ± 1.51 in group A vs 11.32 ± 4.21 in group B, P < .001), TFT (16.57 ± 2.79 in group A vs 26.05 ± 6.18 in group B, P < .001), and operation time (20.05 ± 3.38 in group A vs 25.43 ±5.11 in group B, U < .001) were statistically different in the 2 groups. The incidence of cement leakage that occurred in group A (1/21, 4.76%) was significantly less than that in group B (9/21, 42.9%, P < 0.05). Conclusions. “Targeted PVP” may achieve (1) less skin positioning fluoroscopy times, less total fluoroscopy times and dose, shorter operation time, which is more precise than traditional PVP; (2) less incidence of cement leakage; and (3) visualization of the fractured vertebra, which is probably more valuable for the treatment of complicated OVCF patients.

Background Cement augmentation of pedicle screws to prevent screw loosening is associated with significant complications, such as cement leakage or bone necrosis. Therefore, an alternative strategy to improve pedicle screw anchorage has been recently developed: Polymer reinforcement of pedicle screws uses an in situ melted polymer sleeve in order to enhance screw anchorage. This biomechanical study evaluated the effect of polymer-reinforcement by comparing polymer-reinforced pedicle screws to non-augmented as well as cement-augmented screws under cyclic loading. Methods For each of the two comparisons (polymer-reinforced vs. non-augmented screws and polymer-reinforced vs. cement-augmented screws), polymer-reinforced screws and control screws were placed into the left and right pedicle of seven vertebrae (mean age: 74.0 (SD 9.3) years) to allow for pairwise left–right comparisons. Each screw was subjected to cyclic cranio-caudal loading with an initial load ranging from −50 N to +50 N and with stepwise increasing compressive loads (5 N every 100 cycles) until screw loosening. Findings Polymer-reinforced pedicle screws resisted a higher number of load cycles until loosening than the contralateral non-augmented control screws (4300 SD 2018 vs. 2457 SD 1116 load cycles, p = 0.015). Screw anchorage of polymer-reinforced pedicle screws was comparable to that of cement augmented control screws (3857 (SD2085) vs. 4300 (SD1257) load cycles until failure, p = 0.64). Interpretation Our findings indicate that polymer-reinforcement significantly enhances pedicle screw anchorage in low quality bone and that its effect is similar in size than that of cement augmentation.

Objective To compare cement distribution and leakage for 2 bone cement–augmented screws with different designs of injection holes in patients and the impact of screw locations and bone mineral density (BMD) on the results. Methods This study recruited 40 patients who underwent instrumentation with cement-augmented screws. Screw holes of group A were 4 holes located in the distal one third of screws, while screw holes of group B were 6 holes located in distal, middle, and proximal sites. Postoperative computed tomography images were obtained to evaluate the rate and type of cement leakage and the distribution pattern of cement. The lateral or center position of screw tip, BMD, and T-score were also analyzed for their influence on the results. Results Of 192 screws, 80 (41.7%) exhibited cement leakage on postoperative computed tomography. The incidence of cement distribution in the posterior half and type B leakage in group B was significantly higher compared with group A. In group A, the probability of cement distribution in the posterior half was significantly increased when the screw was laterally inserted. For both groups, the higher incidence of cement distribution in the posterior half was correlated with lower BMD and T-score. Conclusions Our results showed that screws with injection holes closer to the screw tip had higher incidences of distribution in the anterior half of the body and lower incidences of type B leakage. Patients with lower BMD and T-scores should be closely monitored, and a more centered position is recommended for screw insertion.

Background Cement leakage into venous blood posed significant challenge to surgeons. The aim of the study was to create a Peking University First Hospital Score (PUFHS) which could evaluate the probability of vascular cement leakage among spine metastases patients following percutaneous vertebroplasty. Methods The study retrospectively enrolled 272 spine metastases patients treated with percutaneous vertebroplasty. We randomly extracted all enrolled patients as the training or validation group and baseline characteristic comparison was assessed between the two groups. Creation of the PUFHS was performed in the training group and validation of the PUFHS was performed in the validation group. Results Of all the 272 patients, the total number of included vertebrae was 632 and the median treated levels were 2 per patient. Vascular cement leakage occurred in 26.47% (72/272) of patients. The baseline characteristics were comparable between the two groups (P > 0.05). Three risk predictors (primary cancer types, number of treated vertebrae levels, and vertebrae collapse) were included in the PUFHS. The area under the receiver operating characteristic curve (AUROC) of the PUFHS was 0.71 in the training group and 0.69 in the validation group. The corresponding correct classification rates were 73.0 and 70.1%, respectively. The calibration slope was 0.78 (95% confidence interval[CI]: 0.45–1.10) in the training group and 1.10 (95% CI: 0.73–1.46) in the validation group. The corresponding intercepts were 0.06 (95% CI: − 0.04–0.17) and − 0.0079 (95% CI: − 0.11–0.092), respectively. Conclusions Vascular cement leakage is common among spine metastases after percutaneous vertebroplasty. The PUFHS can calculate the probability of vascular cement leakage, which can be a useful tool to inform surgeons about vascular cement leakage risk in advance.

Delayed neurological deficits secondary to percutaneous vertebroplasty caused by cement leakage is a rare condition. Although cement extravasation during percutaneous vertebroplasty is not uncommon, most cases are clinically asymptomatic, and symptomatic cement extravasation that requires surgical excision is rarely reported. Herein, a case of L4 radiculopathy secondary to cement leakage is reported that involved the delayed onset of neurological symptoms. The patient was treated using a minimally invasive transforaminal endoscopic approach. The clinical and imaging findings and treatment methods are discussed.