Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty
Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty
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基椎孔可能与椎内裂口相连：经皮椎体后凸成形术中骨水泥渗漏的潜在危险因素。
DOI：
10.1016/j.spinee.2013.09.025
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发表时间：
2014-08-01
期刊：
影响因子：
4.5
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Wang, Chongyan;Fan, Shunwu;Zhao, Fengdong
背景：在骨质疏松性椎体压缩骨折经皮椎体后凸成形术（PKP）中不同类型的骨水泥渗漏中，椎管渗漏被认为是最常见的并发症。导致此类骨水泥渗漏的一种潜在结构是椎体孔与椎内裂之间的潜在连接，该结构在磁共振（MR）图像上清晰显示，但在文献中经常被忽视。目的：本研究的目的是评估有或没有椎内裂的 PKP 中不同类型骨水泥渗漏的发生率，并确定椎管孔是否可以与椎内裂相连。设计：本研究是对骨质疏松椎体椎体内裂的存在以及 PKP 后放射线照片、计算机断层扫描 (CT) 扫描和 MR 图像上不同类型骨水泥渗漏的回顾性评估。患者样本：共有 164 名连续患者接受 PKP 治疗 204 例骨质疏松性椎体压缩性骨折。结果指标：结果指标包括不同类型骨质疏松性椎体压缩性骨折的发生情况。方法：连续 164 例接受 PKP 治疗骨质疏松性椎体压缩骨折的患者中，共 204 块椎骨根据治疗节段的术前 X 线片、CT 扫描和/或 MR 图像分为两种类型：裂隙型（椎体内有椎内裂）和小梁型（无椎体内裂）。椎内裂隙）。当发现椎内裂隙时，研究人员检查了基椎孔，并在三维 CT 扫描和 MR 图像上寻找两个结构之间的通信。在术后直接图像上，骨水泥渗漏的模式分为五种类型：A型，通过皮质缺损进入椎旁软组织；A型，通过皮质缺损进入椎旁软组织； B型，通过基椎孔； C型，通过针通道； D型，通过皮质缺损进入椎间盘间隙；和E型，通过椎旁静脉。回顾性分析了骨水泥渗漏的分布与椎内裂隙的存在之间的关系。此外，还评估了 B 型渗漏与基底椎孔和椎内裂之间的连通的关系。 结果：确定骨水泥渗漏类型和椎内裂是否存在的观察者间平均 kappa 值分别为 0.916（范围为 0.792-1）和 0.935。 204 块椎骨中有 41 块（19.9%）在术前影像中证实存在椎内裂隙。 10 块椎骨（24.4%）发现椎内裂和椎体孔之间有连通。小梁模式组的骨水泥渗漏率为 36.2%，裂隙模式组的骨水泥渗漏率为 41.5% (p>.05)。通过基椎孔渗漏（B 型；N=30，14.7%）和通过皮质缺损进入椎间盘间隙（D 型；N=14，6.9%）比其他类型更常见。 163 块具有小梁模式的椎骨中的 20 块（12.3%）和 41 块具有裂隙模式的椎骨中的 10 块（24.4%）被确定为 B 型渗漏，达到统计学显着性（p
BACKGROUND CONTEXT: Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature.PURPOSE: The purpose of this study is to assess the incidence rate of different types of cement leakage in PKP with or without intravertebral clefts and to determine whether the basivertebral foramen could be connected to the intravertebral cleft.STUDY DESIGN: This study is a retrospective assessment of the presence of an intravertebral cleft in osteoporotic vertebral bodies and the different types of cement leakage after PKP on radiographs, computed tomographic (CT) scans, and MR images.PATIENT SAMPLE: A total of 164 consecutive patients underwent PKP to treat 204 osteoporotic vertebral compression fractures.OUTCOME MEASURES: Outcome measures include the occurrence of different types of cement leakage in the groups with an intravertebral cleft and without intravertebral clefts.METHODS: A total of 204 vertebrae in 164 consecutive patients who underwent PKP to treat osteoporotic vertebral compression fractures were classified into two patterns based on preoperative radiographs, CT scans, and/or MR images of the treated levels: cleft pattern (with an intravertebral cleft in the vertebral body) and trabecular pattern (without intravertebral clefts). When an intravertebral cleft was identified, the investigators examined the basivertebral foramen and looked for a communication between the two structures on three-dimensional CT scans and MR images. On direct postoperative images, the patterns of cement leakage were classified as five types: type A, through a cortical defect into the paraspinal soft tissues; type B, through the basivertebral foramen; type C, via the needle channel; type D, through a cortical defect into the disc space; and type E, via the paravertebral vein. The association of the distribution of the cement leakage and the presence of an intravertebral cleft was analyzed retrospectively. Moreover, the association of type B leakage with the communication between the basivertebral foramen and the intravertebral cleft was also assessed.RESULTS: The average interobserver kappa values for determining the type of cement leakage and the presence of intravertebral cleft were 0.916 (range, 0.792-1) and 0.935, respectively. In 41 of 204 vertebrae (19.9%), an intravertebral cleft was confirmed on preoperative images. A communication between the intravertebral cleft and the basivertebral foramen was seen in 10 vertebrae (24.4%). Cement leakage was 36.2% in the group with a trabecular pattern and 41.5% in the group with a cleft pattern (p>.05). Leaks through the basivertebral foramen (type B; N=30, 14.7%) and through cortical defects into the disc space (type D; N=14, 6.9%) were more common than other types. Twenty of 163 vertebrae with the trabecular pattern (12.3%) and 10 of 41 vertebrae with the cleft pattern (24.4%) were identified as type B leaks, which reached statistical significance (p