Effect comparison of vertebroplasty with bone cement of different viscosity for the treatment of vertebral osteonecrosis

  Objective  To compare the clinical outcomes of high- and low-viscosity cement percutaneous vertebroplasty (PVP) for the treatment of vertebral osteonecrosis and its complications.

  Methods  Thirty-two patients suffering from osteoporotic vertebral osteonecrosis were randomly assigned into high-viscosity group(n=15) and low-viscosity group(n=17). Intraoperative X-ray times, operative time and volume of bone cement injection were recorded. Visual analogue scale (VAS), Oswestry disability index (ODI) scores, 36-Item Short Form Health Survey(SF-36), and radiographic measurement were performed to assess waist-back pain, waist-back function and life quality, relative height of injured vertebrae(%) and its kyphotic angle, respectively. Incidence of complications such as bone cement leakage and vertebral fractures in adjacent segments were observed.

  Results  The patients in both groups had smooth operation and completed follow-up for at least 12 months. There was no significant difference in the general data, intraoperative X-ray times, operation time and volume of bone cement injection between the two groups (P>0.05). Significant improvement on the VAS, ODI scores, SF-36 score, vertebral height (%) and kyphosis Cobb′s angle were noted in each group compared with treatment before. However, there were no significant differences in the same postoperative time between the 2 groups and at varied time points intra-group(P>0.05). Postoperative X-ray assessment identified cement leakage occurred in 5 vertebrae(33.3%) in high viscosity group, and all of them were intraspinal leakage, while high-viscosity cement group had 10 vertebrae leakage(58.8%), among which 8 was intraspinal leakage, 2 was vertebral side leakage. There were significant differences between the two groups in cement leakage rate(P < 0.05).

  Conclusion  PVP used in osteoporotic vertebral osteonecrosis has better clinical efficacy, which can significantly relieve back pain, improve lower back function and quality of life. Furthermore, high-viscosity cement can reduce the cement leakage rate and greatly enhance operative safety.