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Cement leakage during vertebroplasty can be predicted on preoperative MRI
Akio Hiwatashi1, Yoshimitsu Ohgiya, Naoya Kakimoto
1Division of Diagnostic and Interventional Neuroradiology, Department of Imaging Services, University of Rochester Medical Center, Rochester, NY, USA.
Objective:
Previous studies have shown that cement leakage into an adjacent disk space is a risk factor for new fracture after vertebroplasty. The purpose of this study was to investigate the use of preoperative MRI for predicting such cement leakage.
Materials And Methods:
Our institutional review board approved this retrospective study and waived the requirement of informed consent. We studied preoperative MRI of 46 vertebroplasty patients (107 vertebral bodies). Endplate cortical defect, abnormal T2 hyperintensity in adjacent disk space, intravertebral cleft, degree of compression, and wedge angle were correlated to the incidence of cement leakage into the adjacent disk. Patient age, sex, and location of treated vertebral body were also evaluated. We used logistic regression analysis and Fisher's exact probability test to analyze the association between cement leakage and these observations.
Results:
Cortical defect in the endplate of the treated vertebral body, abnormal T2 hyperintensity in the adjacent intervertebral disk, and absence of intravertebral cleft were associated with cement leakage into the disk space (p < 0.05). There was no statistically significant association between cement leakage into the disk and degree of compression, wedge angle, location of treated vertebral body, patient age, or sex (p > 0.05).
Conclusion:
Cement leakage into an adjacent disk is more common when there is a cortical defect in the endplate and increased T2 signal in the adjacent disk and is less common if there is an intravertebral cleft.
Insights
Preoperative MRI can predict cement leakage during vertebroplasty. Findings like endplate defects and abnormal disk signals indicate higher leakage risk, while intravertebral clefts suggest lower risk.
Area of Science:
- Orthopedics
- Radiology
- Spinal Surgery
Background:
- Cement leakage into adjacent disk spaces after vertebroplasty is a known risk factor for new fractures.
- Predictive imaging markers for cement leakage are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the utility of preoperative magnetic resonance imaging (MRI) in predicting cement leakage into the adjacent disk space following vertebroplasty.
Main Methods:
- Retrospective analysis of preoperative MRI scans from 46 patients (107 vertebral bodies) undergoing vertebroplasty.
- Correlation of imaging findings (endplate cortical defect, adjacent disk T2 hyperintensity, intravertebral cleft, compression degree, wedge angle) with cement leakage.
- Logistic regression and Fisher's exact test were used for statistical analysis.
Main Results:
- Cortical defects in the endplate and abnormal T2 hyperintensity in the adjacent disk were significantly associated with cement leakage (p < 0.05).
- Absence of an intravertebral cleft was also linked to increased cement leakage.
- No significant association was found between cement leakage and compression degree, wedge angle, patient age, or sex.
Conclusions:
- Preoperative MRI findings, specifically endplate defects and adjacent disk T2 signal, are valuable predictors of cement leakage during vertebroplasty.
- The presence of an intravertebral cleft may indicate a lower risk of cement leakage.