Predictive Factors for Bone Cement Displacement following Percutaneous Vertebral Augmentation in Kümmell's Disease

Abstract

Objective: To investigate the independent influencing factors of bone cement displacement following percutaneous vertebral augmentation (PVA) in patients with stage I and stage II Kümmell’s disease. Methods: We retrospectively reviewed the records of 824 patients with stage Ⅰ and stage Ⅱ Kümmell’s disease treated with percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) from January 2016 to June 2022. Patients were divided into the postoperative bone cement displacement group (n = 150) and the bone cement non-displacement group (n = 674) according to the radiographic inspection results. The following data were collected: age, gender, body mass index (BMI), underlying disease, bone mineral density (BMD), involved vertebral segment, Kümmell’s disease staging, anterior height, local Cobb angle, the integrity of anterior vertebral cortex, the integrity of endplate in surgical vertebrae, surgical method, surgical approach, the volume of cement, distribution of cement, the viscosity of cement, cement leakage, and postoperative anti-osteoporosis treatment. Binary logistic regression analysis was performed to determine the independent influencing factors of bone cement displacement. The discrimination ability was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC). Results: The results of logistic regression analysis revealed that thoracolumbar junction (odds ratio (OR) = 3.23, 95% confidence interval (CI) 2.12−4.50, p = 0.011), Kümmell’s disease staging (OR = 2.23, 95% CI 1.81−3.41, p < 0.001), anterior cortex defect (OR = 5.34, 95% CI 3.53−7.21, p < 0.001), vertebral endplates defect (OR = 0.54, 95% CI 0.35−0.71, p < 0.001), cement distribution (OR = 2.86, 95% CI 2.03−3.52, p = 0.002), cement leakage (OR = 4.59, 95% CI 3.85−5.72, p < 0.001), restoration of local Cobb angle (OR = 3.17, 95% CI 2.40−5.73, p = 0.024), and postoperative anti-osteoporosis treatment (OR = 0.48, 95% CI 0.18−0.72, p = 0.025) were independently associated with the bone cement displacement. The results of the ROC curve analysis showed that the AUC was 0.816 (95% CI 0.747−0.885), the sensitivity was 0.717, and the specificity was 0.793. Conclusion: Thoracolumbar fracture, stage Ⅱ Kümmell’s disease, anterior cortex defect, uneven cement distribution, cement leakage, and high restoration of the local Cobb angle were risk factors for cement displacement after PVA in Kümmell’s disease, while vertebral endplates defect and postoperative anti-osteoporosis treatment are protective factors.

Keywords: Kümmell’s disease; osteoporosis; percutaneous vertebral augmentation; postoperative complications; risk factors.

Figure 1

A plain radiograph showed whether the bone cement is displaced. (A) Bone cement displacement. (B) Non-bone cement displacement.

Figure 2

A 71-year-old female patient had recurrent low back pain and limited movement 3 years after L₁ vertebroplasty. (A,B): Lumbar positive and lateral X-ray films scanning at 36 months after PVP showed L₁ vertebral cement displacement and T₁₂ vertebral compression fracture. (C–E): CT cross-section, sagittal plane, and coronal plane showed anterior cortex defect and bone cement displacement of the L₁ vertebral body and compression fracture of the T₁₂ vertebral body. (F–H): T₁W₁ showed low signal intensity, and T₂W₁ showed high signal intensity at the L₁ vertebral body. (I,J): The positive and lateral positions of X-ray films showed that after posterior thoracolumbar bone graft fusion and bone cement enhanced internal fixation.

Figure 3

The lateral radiograph showed the measurement of the anterior vertebral height and the local Cobb angle. (A) On the preoperative lateral radiographs, the anterior height of the fractured vertebra, the upper adjacent vertebral anterior height, the lower adjacent vertebral anterior height, and the Cobb angle were measured. (B) On the postoperative lateral radiographs, the anterior height of the fractured vertebra, the upper adjacent vertebral anterior height, the lower adjacent vertebral anterior height, and the Cobb angle were measured. The red line is the endplate and the blue line is the anterior vertebral height.

Figure 4

Risk factors of postoperative bone cement displacement in Kümmell’s disease.

Figure 5

Receiver operating curves (ROC) for the prediction performance of the logistic regression model.