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

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Abstract

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.

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Funding

The study did not receive any funding which needs to be declared, and none of the authors have any financial interests in this subject matter.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK

    L. D. Rose, G. Bateman & A. Ahmed

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  1. L. D. Rose
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  2. G. Bateman
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  3. A. Ahmed
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Contributions

LR: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. Drafted the work or revised it critically for important intellectual content. Approved the version to be published. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to L. D. Rose.

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None of the authors have any conflicts of interest or competing interests to declare with this manuscript.

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No ethical approval was required for this study, as it was retrospectively collected clinical data.

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Rose, L.D., Bateman, G. & Ahmed, A. Clinical significance of cement leakage in kyphoplasty and vertebroplasty: a systematic review. Eur Spine J 33, 1484–1489 (2024). https://doi.org/10.1007/s00586-023-08026-3

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  • DOI: https://doi.org/10.1007/s00586-023-08026-3

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