Risk factors associated with bone cement leakage following percutaneous kyphoplasty: a retrospective analysis

Percutaneous kyphoplasty (PKP) is a minimally invasive procedure in which bone cement is injected into a damaged vertebral body to rapidly alleviate pain and stabilize the spine. The most common complication associated with this procedure is bone cement leakage. Following leakage, compression can occur, potentially leading to severe clinical consequences such as paraplegia, spinal cord compression, cement pulmonary embolism, and even death. This study aims to analyze the risk factors for bone cement leakage in patients with osteoporotic vertebral compression fractures (OVCF) following PKP, and to develop a nomogram to predict the risk of recurrent fractures.

This retrospective cohort study included 308 patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous kyphoplasty (PKP) treatment between January 2021 and December 2024 involving 349 vertebral bodies. The patients were divided into two groups based on the presence or absence of bone cement leakage: the control group (n = 280) and the cement leakage group (n = 69). Clinical, imaging, and surgical data were analyzed, and the following potential risk factors were identified: age, gender, height, weight, BMI, hypertension, diabetes, disease duration, trauma, fracture site, volume of bone cement, NRS (Numerical Rating Scale), bone mineral density (BMD), preoperative vertebral height, postoperative vertebral height, type of vertebral fracture, cortical continuity status of the vertebral body, integrity of the posterior wall, intervertebral vacuum cleft (IVC), and Cobb angle. Based on these factors, we established a Lasso-logistic regression model and evaluated its predictive performance using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Finally, the model was visualized, and a nomogram was generated. This study followed the STROBE reporting guidelines.

Binary logistic regression revealed that hypertension, the degree of vertebral collapse, cortical continuity status of the vertebral body, intact posterior wall, segments (T6, T8), and the volume of bone cement are independent risk factors for bone cement leakage.