The Relationship between Perivertebral Venous Cement Embolism and Balloon Expansion Pressure in Balloon Kyphoplasty

INTRODUCTION: Osteoporotic vertebral compression fractures (OVCFs) are common fractures in the elderly suffering osteoporosis. Most patients have bone fusion with deformity of vertebral collapse; however, some patients suffer nonunion and persistent pain at the fracture site. Due to the limitations of conservative treatment, balloon kyphoplasty (BKP) has been recently performed for OVCFs. This study aimed to investigate the relationship between cement embolization and balloon expansion pressure (BEP) in patients who underwent BKP. METHODS: We investigated 62 patients who underwent BKP for cement embolization into the perivertebral veins among the 155 patients admitted to our hospital due to thoracolumbar vertebral compression fractures between April 1, 2019, and March 31, 2020. Surgery was indicated for patients who had severe back or low back pain and whose daily life was severely impaired, and in whom the shape of the vertebral body was clearly changed on functional X-ray. RESULTS: Intraoperative X-ray and postoperative CT revealed cement embolization into the perivertebral veins in three cases (4.83%). The BEP was significantly higher in the group with cement embolism than in the group without cement embolism (P < 0.001). Pulmonary cement embolism (PCE) and infection were not observed. One case of cement leakage into the spinal canal was observed (1.61%). CONCLUSIONS: While the surgical intervention of BKP can contribute to the treatment of OVCFs, careful attention should be paid to the prevention of complications, including cement embolization into the perivertebral veins, and such complications should be appropriately managed.