Efficacy and Safety of High-Viscosity Bone Cement in Percutaneous Vertebroplasty for Kummell's Disease

Abstract

Background: To analyze and evaluate the clinical outcomes of using high-viscosity bone cement compared to low-viscosity bone cement in percutaneous vertebroplasty (PVP) for treatment of Kummell's disease.

Methods: From July 2017 to July 2019, 68 Kummell's disease patients who underwent PVP were chosen and separated into 2 groups: H group (n = 34), were treated with high-viscosity bone cement and L group (n = 34), treated with low-viscosity bone cement during treatment. The operation time, number of fluoroscopy tests done, and amount of bone cement perfusion were recorded for both groups. Clinical outcomes were compared, by measuring their Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Kyphosis Cobb's angle, vertebral height compression rate, and other complications.

Results: High-viscosity group showed less operation time and reduced number of fluoroscopy tests than the low-viscosity group (P < 0.05). When compared to preoperative period, both groups' VAS and ODI scores were significantly reduced at 1 day and 1 year postoperatively (P < 0.05). The vertebral height compression rate and Cobb's angle were significantly lower (P < 0.05) in both groups after surgery compared with those before surgery (P < 0.05). The cement leakage rate in group H was 26.5%, which was significantly lower than that in group L, which was 61.8% (P < 0.05).

Conclusions: High-viscosity and low-viscosity bone cement in PVP have similar clinical efficacy in reducing pain in patients during the treatment, but in contrast, high-viscosity bone cement shortens the operative time, reduces number of fluoroscopy views and vertebral cement leakage and improves surgical safety.

Keywords: Bone cement; Cement leakage; Compression fractures; High-viscosity; Kummell’s disease; Low-viscosity; Pulmonary embolism; Vertebroplasty.

Fig. 1

Distribution of vertebral segments and cases of Kummell’s disease

Fig. 2

A 78-year-old female with a compression fracture at the L1 Vertebral body in group H was treated with PVP using high-viscosity bone cement. Anteroposterior X-ray film a and lateral X-ray film b revealed a compression fracture of the L1 vertebral body

Fig. 3

Coronal CT scan (c), sagittal CT scan (d) and Transverse CT scan (e) confirmed intraosseous vacuum phenomenon. MRI suggests low signal at T1 (f), high signal at T2 (g)

Fig. 4

Coronal CT scan (h), sagittal CT scan (i) and Transverse CT scan (j) obtained postoperatively showing satisfactory vertebral height and bone cement filling without bone cement leakage

Fig. 5

A 84-year-old female with a compression fracture at the T8 Vertebral body in group L was treated with PVP using low-viscosity bone cement. Anteroposterior X-ray film (k) and lateral X-ray film (l) revealed a compression fracture of the T8 vertebral body

Fig. 6

Coronal CT scan (m), sagittal CT scan (n) and Transverse CT scan (o) confirmed intraosseous vacuum phenomenon. MRI suggests low signal at T1 (p), high signal at T2 (q)

Fig. 7

Coronal CT scan (r), sagittal CT scan (s) and Transverse CT scan (t) obtained postoperatively showing satisfactory vertebral height and bone cement filling accompanied by paravertebral cement leakage