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Risk factors for intravertebral cleft in acute vertebral fractures and its relationship with bone cement leakage
Yi Guo1, Lin Du2,3, Junbang Feng1
1Medical Imaging Department, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing, China.
Background:
Intravertebral cleft (IVC) is a linear intravertebral imaging characteristic in fractured vertebrae filled with liquid or gas, once considered specific to Kummell's disease but now also observed in acute traumatic fractures, and its risk factors and relationship with bone cement leakage after percutaneous vertebroplasty (PVP)/percutaneous kyphoplasty (PKP) remain to be explored. The study aims to identify IVC risk factors in acute vertebral fractures (AVFs) patients and assess its link to bone cement leakage post-PVP/PKP.
Methods:
A total of 1,612 patients diagnosed with AVF at two medical centres were retrospectively included. The diagnostic criterion for IVC was the presence of linear intravertebral lesions filled with liquid or gas in computed tomography (CT) and magnetic resonance imaging (MRI). A total of 126 patients (127 vertebrae) were diagnosed with intravertebral fissures and included in the IVC group, while 125 age- and sex-matched patients (134 vertebrae) without IVC were included in the control group. Clinical and imaging characteristics, including demography, osteoporosis severity, and vertebral fracture line involvement, were compared between the two groups. In patients who underwent PKP or PVP within three months, the incidence and types of bone cement leakage were analysed.
Results:
The compression severity and vertebral fracture line involvement of the inferior endplate, posterior wall, and basivertebral foramen significantly differed between the IVC and control groups (P<0.05). Vertebral fracture line involvement of the basivertebral foramen was a risk factor for IVC [95% confidence interval (CI): 2.297 (1.303-4.048), P=0.004]. An interaction effect between vertebral fracture line involvement of the basivertebral foramen and the posterior wall was observed (P<0.05). Within 3 months, 64 vertebrae underwent PKP or PVP in the IVC group, and 15 cases (23.438%) exhibited leakage. Sixty-one vertebrae in the control group underwent PKP or PVP, with 6 cases (10.000%) exhibiting leakage. There was a significant difference between the two groups (P=0.042). C-type leakage was the most common type in the IVC group, accounting for 86.7% (13/15) of all cases.
Conclusions:
A basivertebral foramen fracture is an IVC risk factor for AVF. AVF with IVC significantly increases bone cement leakage risk after PVP/PKP.
