Osteoporosis International

, Volume 23, Issue 10, pp 2559–2565 | Cite as

What is the importance of “halo” phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture?

  • K. H. Kim
  • S. U. Kuh
  • J. Y. Park
  • K. S. Kim
  • D. K. ChinEmail author
  • Y. E. Cho
Original Article



We investigated the importance, risk factors, and clinical course of the radiolucent “halo” phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture. Preoperative osteonecrosis and a lump cement pattern were the most important risk factors for the peri-cement halo phenomenon, and it was associated with vertebral recollapse.


We observed a newly developed radiolucent area around the bone cement following vertebral augmentation for osteoporotic compression fractures. Here, we describe the importance of the peri-cement halo phenomenon, as well as any associated risk factors and long-term sequelae.


In total, 175 patients (202 treated vertebrae) were enrolled in this study. The treated vertebrae were subdivided into two groups: Group A (with halo, n = 32) and Group B (without halo, n = 170), and the groups were compared with respect to multiple preoperative (age, sex, BMD, preoperative osteonecrosis) and perioperative factors (operative approach: vertebroplasty or kyphoplasty; cement distribution pattern; cement leakage; cement volume), and postoperative results (VAS score, recollapse). Logistic regression analysis was used to evaluate the relationship between the incidence of the peri-cement halo and all of the parameters described above.


Rates of osteonecrosis were also significantly higher in Group A than in Group B (62.5% vs. 31.2%, p < 0.05), and kyphoplasty (KP) was performed more frequently in Group A (43.8% vs. 17.6%, p < 0.05). Lump cement (93.8% vs. 30.6%, p < 0.05) and recollapse (78.1% vs. 24.7%, p < 0.05) were also more common among individuals in Group A. Logistic regression analysis also showed that preoperative osteonecrosis (OR = 3.679; 95% CI = 1.677–8.073; p = 0.001), KP (OR = 3.630; 95% CI = 1.628–8.095; p = 0.002), lump pattern (OR = 13.870; 95% CI = 2.907–66.188; p = 0.001), and vertebral recollapse (OR = 5.356; 95% CI = 1.897–15.122; p = 0.002) were significantly associated with peri-cement halo.


The peri-cement halo was found to be associated with vertebral recollapse, this sign likely represents a poor prognostic factor after vertebral augmentation for osteoporotic compression fractures.


Cement distribution Kyphoplasty Osteonecrosis Osteoporotic vertebral compression fracture Recollapse Vertebroplasty 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • K. H. Kim
    • 1
  • S. U. Kuh
    • 1
  • J. Y. Park
    • 1
  • K. S. Kim
    • 1
  • D. K. Chin
    • 1
    Email author
  • Y. E. Cho
    • 1
  1. 1.Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea

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