Individualized treatment selection and effect evaluation for intraspinal cement leakage after percutaneous vertebroplasty / 中华创伤杂志

ABSTRACT

Objective:To explore different surgical treatment options and effect for intraspinal cement leakage after percutaneous vertebroplasty (PVP).Methods:A retrospective case series study was carried out to analyze the clinical data of 5 patients with intraspinal cement leakage after PVP for osteoporotic vertebral compression fracture (OVCF) admitted to People's Hospital of Shanxi between May 2016 and January 2020, including 1 male and 4 females, with the age of 65-82 years [(75.4±7.5)years]. Injured segments were located at T 12-L 1 in 1 patient, L 1 in 1, L 2-4 in 1, L 3 in 1 and L 4-5 in 1. The American Spinal Injury Association (ASIA) classification was grade C in 2 patients and grade D in 3. Muscle strength was grade II in 2 patients and grade III in 3. The leakage of bone cement in the spinal canal was strip or columnar in 3 patients, leaning to one side of the spinal canal and adjacent to the nerve root, and the bone cement was removed by transforaminal endoscope for decompression. The leakage of bone cement in the dura mater and spinal canal was found in 2 patients. The intradural bone cement leakage was removed by durotomy, and the bone cement in the spinal canal was removed by transpedicular osteotomy, bone graft fusion and internal fixation. The visual analogue scale (VAS), Oswestry dysfunction index (ODI), ASIA grade and muscle strength were observed before operation, at 3 days, 3 months after operation and at the last follow-up. Results:All patients were followed up for 12-16 months [(13.6±1.8)months]. The VAS was significantly decreased at postoperative 3 days, 3 months and at the last follow-up [(2.6±0.6)points, (2.1±0.3)points, (1.9±0.5)points] when compared to (7.1±1.5)points before operation ( P<0.01). However, the VAS had no statistical difference at different time points after operation ( P>0.05). The ODI was 42.4±10.2, 25.6±6.0 and 21.4±3.6 at postoperative 3 days, 3 months and at the last follow-up, significantly different from that before operation (74.2±7.3) ( P<0.05 or 0.01). However, the ODI had no statistical difference at postoperative 3 months and at the last follow-up ( P>0.05). Two patients with preoperative ASIA grade C recovered to grade D and 3 patients with preoperative grade D recovered to grade E at the last follow-up ( P<0.05). Two patients could walk without crutches with muscle strength improved from grade II preoperatively to grade IV at the last follow-up ( P<0.01). Three patients had completed recovery of neurological function with muscle strength improved from grade III preoperatively to grade V at the last follow-up ( P<0.01). Conclusions:For OVCF patients with intraspinal canal cement leakage and neurological symptoms after PVP, if the bone cement is located on one side of the spinal canal and adjacent to the nerve root, the bone cement should be removed by foraminal endoscope for decompression; if the cement leakage occurs in the dura mater, the dura mater should be cut to remove the bone cement for decompression, which can effectively relieve pain and promote functional recovery.