Neither subendplate cement deposition nor cement leakage into the disk space during vertebroplasty significantly affects patient outcomes

Abstract

Purpose: To determine the impact of cement placement immediately adjacent to and through the endplate during percutaneous vertebroplasty on postprocedural pain and subsequent fracture rate.

Materials and methods: Institutional review board approval with waived consent was obtained. Medical records of 424 patients undergoing first-time, single-level vertebroplasty for osteoporotic or traumatic compression fractures were examined. Data regarding pain at rest and with activity before the procedure, along with timing and level of subsequent fractures over a 24-month period, were collected. Group 1 (n=64) included patients with no cement extension to the endplate(s), group 2 (n=216) included those with cement extension to the endplate(s) but no leakage into the disk space(s), and group 3 (n=144) included those with cement extension to the endplate(s) and cement leakage into the disk space(s). Analysis of variance and Fisher test were used to analyze the data, with significance set at P<.05.

Results: Baseline characteristics and demographics were similar among the groups. At 1 month, for groups 1, 2, and 3, the respective mean postprocedural pain numeric scores at rest were 1.4±2.7, 1.4±2.4, and 1.6±2.5 (P=.51), while the respective pain scores with activity were 4.3±2.9, 3.8±3.1, and 3.9±3.3 (P=.50). Total subsequent fractures were noted in five (8%), 26 (12%), and 15 (10%) patients in group 1, 2, and 3, respectively (P=.77).

Conclusion: Neither extension of cement to the endplate nor cement leakage into the disk space has significant impact on postprocedural pain or subsequent fracture rate at 2 years.