Rad, Arash Ehteshami

Background Reported incidence of extravertebral cement leakage after vertebroplasty varies widely across studies. Purpose To retrospectively compare the relative detection rates of extravertebral leakage noted under intra-procedural fluoroscopic surveillance, postprocedure plain radiographs, and postprocedure computed tomography (CT) in a cohort of patients undergoing vertebroplasty. Material and Methods With IRB approval, we retrospectively identified 181 patients with 277 levels treated with percutaneous vertebroplasty among a total of 1255 patients undergoing vertebroplasty between 1999 and 2010 who had subsequently undergone a CT examination that included the treated level(s). Categories of leakage were paravertebral, end plate, epidural, and prevertebral venous leakage. CT-detected leak rates were then compared to those noted on the vertebroplasty procedure reports and the archived fluoroscopic images for this same cohort using Pearson's χ 2 test. Results One hundred and forty-nine (82%, 95% CI 76–87%) of 181 patients demonstrated evidence of some type of leakage on CT at one or more treated levels. Sixty-two (34%, 95% CI 28–42%) and seventy-seven (50%, 95% CI 43–57%) of 149 CT-detected leaks were reported in the procedural dictation or detected on plain radiography ( P = 0.01 and 0.006, respectively). The most common type of leakage noted on CT was end plate ( n = 81, 45%, 95% CI 38–52%), followed by paravertebral ( n = 64, 35%, 95% CI 29–43%), epidural ( n = 36, 20%, 95% CI 15–26%), and prevertebral venous ( n = 32, 18%, 95% CI 13–24%). Conclusion Cement leakage after vertebroplasty is common and is often not reported by operators in procedural dictations. CT detects substantially more leaks than plain radiography.

Background Increased mobility and physical activity after successful vertebral augmentation procedure might increase the risk of new-onset fractures. Purpose To determine whether new-onset fracture following vertebroplasty is associated with specific type of physical activity. Material and Methods A total of 107 patients underwent at least two procedures of percutaneous vertebroplasty. Among them, 30 patients who sustained a post-vertebroplasty fracture(s), were stratified by fracture-causing activity and examined the incidence of the initial and post-vertebroplasty fractures, time to post-vertebroplasty fractures, duration of anti-osteoporotic therapy, T-score, and body mass index. Results The following percentages correspond to patients with fractures sustained pre- and post-vertebroplasty, respectively; spontaneous fractures in 17% and 7% ( P = 0.20), sitting in 7% and 3% ( P = 0.50), walking or standing in 7% and 20% ( P = 0.10), housework in 3% and 3% ( P > 0.99), coughing or sneezing in 0% and 20% ( P = 0.003), exercise in 7% and 17% ( P = 0.20), lifting in 10% and 17% ( P = 0.40) and falling in 50% and 13% ( P = 0.002). Different levels of activity were not significantly associated with time to incidence of post-vertebroplasty fractures. Anti-osteoporotic medications were administered to 33% of patients before vertebroplasty and 37% after the vertebroplasty ( P = 0.78); medications were administered to these groups for 16 and 25 months, respectively ( P = 0.39). Conclusion A significantly elevated risk of new onset fracture with increased physical activity was not identified. However, patients should be carefully counseled after vertebroplasty to optimize medical therapy for osteoporosis and also to use extreme care when engaging in even moderate physical activity.