Effect of Cold Saline Pre-Washing on Cement Leakage in Vertebroplasty: A Novel Approach

Background: Cement leakage remains a significant challenge in percutaneous vertebroplasty (PVP). Leakage can lead to serious complications, including spinal cord compression, pulmonary embolism, and nerve root irritation. While several techniques have been proposed to minimize leakage, an effective and simple solution is still needed. This study investigates the impact of pre-washing vertebral bodies with cold saline before cement injection as a potential method to reduce leakage. Methods: A retrospective analysis was conducted on patients who underwent PVP for osteoporotic vertebral compression fractures. Patients were divided into three groups: (1) conventional PVP, (2) PVP with room-temperature saline pre-injection, and (3) PVP with cold saline (4 °C) pre-injection. Cement leakage was assessed using intraoperative fluoroscopy and postoperative computed tomography (CT), categorized into paravertebral, intervertebral, retrograde, spinal canal, and distant venous leakage. Statistical analysis was performed to compare leakage rates among the groups. Results: A total of 262 patients with 461 treated vertebrae were analyzed. Cold saline pre-treatment significantly reduced cement leakage rates compared to conventional PVP and room-temperature saline pre-injection (p < 0.05). CT imaging detected significantly more cement extravasation than fluoroscopy (p < 0.01). The incidence of spinal canal and intervertebral leakage was lowest in the cold saline group, suggesting improved cement containment and distribution. Conclusions: Pre-washing vertebral bodies with cold saline before cement injection in PVP significantly reduces cement leakage, particularly in the spinal canal and intervertebral spaces. This simple and cost-effective approach may enhance surgical safety and improve patient outcomes.