A retrospective study identifying the primary source of hidden blood loss during vertebroplasty

Vertebroplasty has been widely applied to the treatment of osteoporotic vertebral fractures. The surgery may cause significant hidden blood loss, which can be devastating for elderly people. We analyzed a series of cases to determine which anatomical site contributes most to perioperative hidden blood loss and to optimize the surgical technique for reducing this loss. A retrospective review was conducted on 352 patients who underwent vertebroplasty for osteoporotic vertebral fractures between January 2020 and November 2023. The patients were categorized into 3 groups: group 1, single fractured vertebral body with unilateral puncture; group 2, single fractured vertebral body with bilateral puncture; and group 3, double fractured vertebral bodies with unilateral puncture. The volume of hidden blood loss was calculated using a specific formula and analyzed statistically using SPSS software. The mean hidden blood loss in group 1 was 68.63 ± 27.43 mL, accounting for bleeding from 1 side of the paraspinal muscles and 1 vertebral body. In group 2, the mean hidden blood loss was 102.43 ± 45.65 mL, involving bilateral paraspinal muscles and 1 vertebral body. Group 3 exhibited a mean hidden blood loss of 98.34 ± 36.87 mL, involving bilateral paraspinal muscles and 2 vertebral bodies. Statistically significant differences were observed between group 1 and group 2, as well as between group 1 and group 3, while no significant difference was found between group 2 and group 3. The paravertebral muscles are identified as the primary source of hidden blood loss during vertebroplasty. To reduce this blood loss, unilateral puncture is recommended to limit paravertebral muscle injury.