Effect of the Location of Endplate Cement Extravasation on Adjacent Level Fracture in Osteoporotic XXXX Undergoing Vertebroplasty and Kyphoplasty.

@entity3604 @entity1 @entity174 @entity5 @entity170 @entity661 @entity130
BACKGROUND: The most widely researched risk/complication following vertebroplasty (VP) or kyphoplasty (KP) is that of @entity174 ( @entity174 ). Current literature results regarding the effect of intradiscal extravasation of cement on the risk of @entity174 is conflicting with about half of the studies concluding there is no added risk with endplate extravasation and half of the studies reporting opposite conclusions. OBJECTIVE: The purpose of the study is to further stratify the data to determine whether specifically the location and extent of endplate cement extravasation more strongly affect @entity174 risk in @entity3604 @entity1 following either @entity661 . STUDY DESIGN: Retrospective cohort study. SETTING: University teaching hospitalMETHODS: One hundred and fifty-six cemented levels in 80 @entity1 , treated at a single center between 2008 and 2012 were reviewed. Age, gender, T-score, body mass index, and @entity170 type (primary or secondary) were recorded. An @entity174 was defined as a @entity174 : 1) in a non-cemented vertebra; 2) adjacent to a cemented level; and 3) not due to @entity130 or @entity5 . Location of the cement extravasation (anterior, middle, or posterior third of the vertebral body) and extravasation extent (percentage of the intervertebral disc height occupied by the bolus) were measured. A logistic modeling strategy permitted examining the association between the location and extent of extravasation and the odds of @entity174 . RESULTS: @entity174 occurred in 14 of the 52 @entity1 (27%) and 20 of the 98 levels (20.4%) remaining after exclusions. Odds of @entity174 were 5.9 times higher (95% CI: 1.6 to 21.2, P = 0.008) with extravasation when compared to no leakage. Odds of @entity174 in a given @entity1 were 22.6 times higher (95% CI: 3.0 to 170.9, P = 0.003) with anterior extravasation when compared to no leakage. Leakage in the middle or posterior thirds and extent of extravasation were not associated with @entity174 . LIMITATIONS: Limitations of the study include the retrospective study design and small sample size as well as the retrospective implementation of follow-up criteria posing risk of selection bias. CONCLUSIONS: Cement endplate extravasation isolated to the anterior third of the vertebral body is associated with is significantly higher odds of @entity174 after VP or KP in @entity1 with @entity170 .
