Risk factors for bone cement dislodgement following balloon kyphoplasty for osteoporotic vertebral compression fracture - 11/04/24

Doi : 10.1016/j.neuchi.2024.101559

Kai-Chieh Chang ^a , Chih-Ta Huang ^a,^b , Cheng-Ta Hsieh ^a,^c,^d , Chien-Min Chen ^f,^g , Chih-Ju Chang ^a,^c,^e,⁎
^a Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
^b Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
^c Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
^d School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
^e Department of Mechanical Engineering, National Central University, Taoyuan City, Taiwan
^f Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
^g Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan

^⁎Corresponding author at: Division of Neurosurgery, Department of Surgery, Cathay General Hospital, No. 280, Section 4, Ren’ai Road, Da’an District, Taipei City 106, Taiwan.Division of NeurosurgeryDepartment of SurgeryCathay General HospitalNo. 280, Section 4, Ren’ai Road, Da’an DistrictTaipei City106Taiwan

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Highlights

•	Incidence of bone cement dislodgement (BCD) is particularly high in older patients with complicated osteoporotic vertebral compression fracture.
•	Spilt-type and pedicle fractures contribute to BCD after balloon kyphoplasty (BKP).
•	Patients with posterior wall injury are prone to BCD after undergoing BKP.
•	Presence of intravertebral vacuum cleft also makes patients prone to BCD after BKP.

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Abstract

Objective

The study aimed to determine the incidence and risk factors associated with bone cement dislodgement in patients with osteoporotic vertebral compression fracture following balloon kyphoplasty treatment.

Methods

A retrospective study was conducted on 203 patients who underwent kyphoplasty in 255 vertebral bodies between January 2017 and December 2021. The patients were categorized into two groups: the bone cement dislodgment group (n = 16) and the non-bone cement dislodgement group (n = 239). Various patient characteristics and radiologic parameters were evaluated. Statistical analysis involved the assessment of the background homogeneity of the group by using independent sample t tests, chi-square tests, and Fisher’s exact. Univariate and multivariate logistic regression analyses were performed to explore the impact of background variables on cement dislodgement.

Results

The results revealed that split-type fracture (χ² = 31.706, p < 0.001), DISH (χ² = 18.827, p = 0.011), pedicle fracture (χ² = 22.246, p < 0.001), endplate deficit (χ² = 14.023, p < 0.001), posterior wall injury (χ² = 29.124, p < 0.001), and intervertebral vacuum cleft (χ² = 21.469, p < 0.001) were the factors that significantly differed between the two groups. The multivariate logistic regression analysis revealed posterior wall injury (OR = 12.983, p = 0.025) and intervertebral vacuum cleft (OR = 5.062, p = 0.024) to be independent risk factors.

Conclusion

The incidence of bone cement dislodgement in our study was 6.3%. This study underscores the importance of using preoperative radiologic parameters to predict the risk of bone cement dislodgement following balloon kyphoplasty.

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Keywords : Bone cement dislodgment, Balloon kyphoplasty, Osteoporotic vertebral compression fracture