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Cement Leakage in Percutaneous Vertebroplasty for Spinal Metastases: A Retrospective Evaluation of Incidence and Risk Factors

Corcos, Gabriel MD*; Dbjay, Jonathan MD*; Mastier, Charles MD*; Leon, Sandrine; Auperin, Anne MD; De Baere, Thierry MD, PhD*; Deschamps, Frédéric MD*

doi: 10.1097/BRS.0000000000000134
Clinical Case Series

Study Design. Retrospective assessment of risk factors using univariate and multivariate analyses.

Objective. To evaluate risk factors retrospectively for cement leakage (CL), including vascular cement leakage (vCL) and cortical cement leakage (cCL), in percutaneous vertebroplasty of spinal metastasis.

Summary of Background Data. Complications of vertebroplasty for spine metastasis are rare but related to extravertebral cement leakage that is pulmonary embolism and medullary compression. Better understanding of the risk factors for vascular and cortical types of cement leakage is necessary to prevent these complications.

Methods. Fifty-six cancer patients (30 females, 26 males; age, 56 ± 12 yr) (81 vertebrae) were treated in 58 sessions under fluoroscopy or computed tomography–fluoroscopy guidance. Leakage rates were reported. The following items were assessed for occurrence of CL, vCL, and cCL: primary tumor site, prior radiotherapy or local tumor ablation or embolization, appearance on computed tomography, cortical osteolytic destruction, vertebral collapse, operator's experience, guidance modality, and cement filling.

Results. CL, vCL, and cCL rates were 53%, 25%, and 32%. History of prior treatment correlated with a decrease in CL (P = 0.018). vCL decreased when lung was the primary tumor site (P = 0.036), in osteolytic vertebrae (P = 0.033) or when there was a vertebral collapse (P = 0.037). cCL correlated with operator's experience (P = 0.021) and vertebral collapse (P < 0.001). Superior discal cCL correlated with superior endplate cortical destruction (P = 0.012). Although history of prior treatment seemed to be an independent protective factor (odds ratio = 0.24; 95% confidence interval, 0.087–0.7; P = 0.001), vertebral collapse was isolated as a risk factor for cCL (odds ratio = 32; 95% confidence interval, 6.7–161; P = 0.001).

Conclusion. Risk factors for cCL and vCL are distinct. Vertebral collapse and cortical destruction are risk factors for cCL. History of prior treatment is a protective factor for CL.

Level of Evidence: 4

There are specific risk factors for cortical and vascular cement leakage. Cortical cement leakage correlates with vertebral collapse. More specifically, cortical discal leakage correlates with osteolytic endplate destruction. Primary tumor site, prior radiotherapy or local ablation tumors might affect vascular cement leakage. Cement filling does not correlate with cement leakage.

Departments of *Interventional Radiology and

Biostatistics, Institut Gustave Roussy, Villejuif, France.

Address correspondence and reprint requests to Gabriel Corcos, MD, Department of Interventional Radiology, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94800 Villejuif, France; E-mail:

Acknowledgment date: August 2, 2013. First revision date: November 1, 2013. Acceptance date: November 8, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins