Outcomes of Augmentation in Osteoporotic Vertebral Compression Fractures Showing a Cleft Sign on MRI

Introduction Intravertebral clefts (IVCs) typically occur in association with osteoporotic vertebral compression fractures (OVCFs) and can be characterized based on magnetic resonance imaging (MRI). This study aimed to identify the clinical characteristics of IVCs with different MRI signals and assess their influence on outcomes of vertebral augmentation. Materials and Methods We retrospectively recruited patients with OVCFs and associated IVCs who underwent vertebral augmentation. Patients were stratified into two groups based on whether the IVCs were full of liquid or gas, as determined by MRI signals. Patients were also stratified based on whether vertebral augmentation involved percutaneous kyphoplasty (PKP) or vertebroplasty (PVP). Pre- and postprocedural parameters were compared between groups. Results A total of 194 fractured vertebrae (86 liquid-filled, 108 gas-filled) were examined. Scores for bone cement distribution were significantly higher in the gas group than in the liquid group, indicating broader cement distribution in the gas group. In both groups, intervention significantly improved pain and mobility scores. Among patients with gas-filled IVCs, the incidence of bone cement leakage and recollapse of treated vertebrae were significantly higher after PKP than after PVP. In the liquid group, incidence of bone cement leakage and recollapse of treated vertebrae did not differ significantly between patients who received PKP or PVP. Conclusion Vertebral augmentation is effective for treating OVCFs with gas- or liquid-filled IVCs. However, in patients with gas-filled IVCs, PKP may be associated with higher incidence of cement leakage and recollapse of treated vertebrae than PVP. Liquid-filled IVCs may not promote bone cement distribution.

Automated summary

This study demonstrated the effectiveness of vertebral augmentation in treating OVCFs, with higher incidence of cement leakage and recollapse of treated vertebrae associated with PKP in patients with gas-filled IVCs. Liquid-filled IVCs may not promote bone cement distribution effectively.