Clinical significance of cement leakage in kyphoplasty and vertebroplasty: a systematic review

• Published in: European spine journal Vol. 33; no. 4; pp. 1484 - 1489
• Main Authors: Rose, L. D., Bateman, G., Ahmed, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2024; Springer Nature B.V
• Subjects: Bone surgery; Cement; Clinical trials; Decompression; Embolism; Fractures; Leakage; Medicine; Medicine & Public Health; Meta-analysis; Neurosurgery; Osteoporosis; Review Article; Reviews; Surgical Orthopedics; Systematic review; Vertebrae; Leakage; Vertebroplasty; Complications; Cement; Kyphoplasty
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-023-08026-3

Background
Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are employed to treat those who remain symptomatic, with comparable clinical outcomes. Although PVP is faster and less expensive, concerns around cement-leakage complications make PKP perceptively safer.
Methods
By means of systematic review, we sought to ascertain whether PVP did carry a higher risk of cement-leakage and associated symptomatic complications (neural compromise, pulmonary embolism and need for emergency decompression surgery).
Results
Our search of 138 articles returned six studies after shortlisting and manual review: three randomised-controlled trials, and three retrospective comparative studies which met our criteria and directly compared cement-leakage rates and complications between the two treatments. 532 PVPs and 493 PKPs recorded 213 (39.3%) and 143 (28.9%) leaks, respectively (
p
< 0.0005). Of these, no leaks resulted in any of the aforementioned leak-related complications. No meta-analysis was performed due to heterogeneity of the data.
Conclusions
We therefore concluded that whilst PVP does result in more cement leaks, this does not appear to be clinically significant. Further studies would add weight to this conclusion, and cost-effectiveness should be assessed to restore confidence in PVP.
Level of evidence
Level III Evidence.