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Purpose <p>This study aims to investigate the impact of different bone cement distribution patterns on cement leakage in percutaneous curved vertebroplasty (PCVP) versus bilateral percutaneous vertebroplasty (PVP). We hypothesized that anteriorly displaced cement increases leakage risk and that PCVP produces a more anterior distribution than bilateral PVP.</p> Methods <p>This retrospective analysis included 55 vertebrae treated with bilateral PVP between November 2021 and March 2023 and 60 vertebrae treated with PCVP between April 2023 and September 2024. Variables included age, gender, BMI, bone mineral density, surgical approach, cement distribution pattern (three-part classification on lateral radiographs), and postoperative cement leakage. We utilized a computer software–assisted radiographic analysis to localize the cement centroid and classify position (anterior/central/posterior). Univariate analyses were followed by logistic regression. Inter-observer reliability for the computer-assisted classification was assessed on a random subset [<i>n</i> = 30] using intraclass correlation coefficients (ICC) and Cohen’s κ.</p> Results <p>Cement leakage occurred in 28.6% of anterior, 3.8% of central, and 0% of posterior distributions (<i>P</i> &lt; 0.001). Compared with bilateral PVP, PCVP yielded a substantially higher proportion of anterior distributions (56.5% vs. 29.1%) and a lower proportion of central distributions (32.6% vs. 65.5%; <i>P</i> &lt; 0.001). In multivariable logistic regression, central versus anterior distribution was associated with markedly lower odds of leakage (adjusted OR 0.06, 95% CI 0.02–0.20; <i>P</i> &lt; 0.001), whereas PCVP versus bilateral PVP was not significantly associated with leakage after adjusting for cement position (adjusted OR 0.98, 95% CI 0.27–3.52; <i>P</i> = 0.969).</p> Conclusion <p>Compared with bilateral PVP, PCVP tended to yield a more anterior cement distribution. An anterior distribution was strongly associated with a higher likelihood of cement leakage. Clinically, centering cement within the middle third—particularly during PCVP—may reduce leakage risk.</p>

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The impact of different bone cement distribution patterns on cement leakage in percutaneous curved vertebroplasty versus bilateral percutaneous vertebroplasty

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Xuelin Zhao,
  • Yipeng Yin,
  • Lijun Li

摘要

Purpose

This study aims to investigate the impact of different bone cement distribution patterns on cement leakage in percutaneous curved vertebroplasty (PCVP) versus bilateral percutaneous vertebroplasty (PVP). We hypothesized that anteriorly displaced cement increases leakage risk and that PCVP produces a more anterior distribution than bilateral PVP.

Methods

This retrospective analysis included 55 vertebrae treated with bilateral PVP between November 2021 and March 2023 and 60 vertebrae treated with PCVP between April 2023 and September 2024. Variables included age, gender, BMI, bone mineral density, surgical approach, cement distribution pattern (three-part classification on lateral radiographs), and postoperative cement leakage. We utilized a computer software–assisted radiographic analysis to localize the cement centroid and classify position (anterior/central/posterior). Univariate analyses were followed by logistic regression. Inter-observer reliability for the computer-assisted classification was assessed on a random subset [n = 30] using intraclass correlation coefficients (ICC) and Cohen’s κ.

Results

Cement leakage occurred in 28.6% of anterior, 3.8% of central, and 0% of posterior distributions (P < 0.001). Compared with bilateral PVP, PCVP yielded a substantially higher proportion of anterior distributions (56.5% vs. 29.1%) and a lower proportion of central distributions (32.6% vs. 65.5%; P < 0.001). In multivariable logistic regression, central versus anterior distribution was associated with markedly lower odds of leakage (adjusted OR 0.06, 95% CI 0.02–0.20; P < 0.001), whereas PCVP versus bilateral PVP was not significantly associated with leakage after adjusting for cement position (adjusted OR 0.98, 95% CI 0.27–3.52; P = 0.969).

Conclusion

Compared with bilateral PVP, PCVP tended to yield a more anterior cement distribution. An anterior distribution was strongly associated with a higher likelihood of cement leakage. Clinically, centering cement within the middle third—particularly during PCVP—may reduce leakage risk.