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Assessment of Blood Loss During Kyphoplasty for Neoplastic Vertebral Fractures: Bleeding and Active Lesions in
Bedirhan Albayrak1, Yunus Emre Yildirim2, Ercan Bayar3
1Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital.
Study Design:
Ambispective cohort study.
Objective:
To investigate whether 18F-FDG PET/CT-defined lesion activity predicts intraoperative bleeding risk during percutaneous balloon kyphoplasty (PBK) in patients with multiple myeloma (MM), and to explore the correlation between radiologic restoration and clinical outcomes.
Summary Of Background Data:
PBK is a widely used intervention in the management of painful vertebral compression fractures (VCFs) in MM. Although PET/CT imaging plays a central role in disease monitoring, its potential to predict intraoperative complications such as bleeding has not been established.
Methods:
This study evaluated 26 patients (35 vertebral levels) treated with PBK between June 2021 and January 2024. Data included demographics, radiologic parameters (anterior and mid-vertebral height, local kyphotic angle), functional outcomes (VAS, ODI), and intraoperative bleeding volumes. PET/CT was used to determine lesion activity in MM patients. Logistic regression analysis (Firth method) was used to assess predictors of high bleeding (>100 mL). Statistical comparisons were made based on fracture etiology, spinal level, and age group.
Results:
Among 20 MM patients, 5 had PET/CT-active lesions; 4 of these experienced bleeding ≥100 mL. Mean bleeding was 100 mL in MM and 13 mL in non-MM cases. Firth's logistic regression identified PET/CT-defined lesion activity as a significant predictor of high bleeding risk (OR: 4.81; 95% CI: 1.14-26.2; P<0.05). Radiologic restoration (AVHR, MVHR, LKA) showed no correlation with clinical improvement (VAS/ODI). Cement leakage occurred in 5 cases, with no neurological complications.
Conclusions:
Metabolic activity on PET/CT is a strong and independent predictor of increased intraoperative bleeding risk in MM patients undergoing PBK. Although PBK offers effective radiologic correction, clinical outcomes are not directly associated with anatomical restoration. Preoperative PET/CT may aid in risk stratification and surgical planning for this patient group.
