Leakage of polymethylmethacrylate in percutaneous vertebroplasty: Comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft

Objective: We compared polymethylmethacrylate (PMMA) leakage from vertebral bodies in osteoporotic compression fractures with and without intravertebral vacuum clefts (IVCs) on computed tomography (CT) after vertebroplasty. Methods: Percutaneous vertebroplasty was performed in 59 patients, comprising 36 compression fractures with IVCs in 33 patients and 49 fractures without IVCs in 26 patients. All patients underwent post-procedural CT of treated and adjacent vertebral bodies. CT findings and clinical complications were assessed retrospectively with regard to the presence of PMMA leakage. When present, leakage types were classified as intradiscal, epidural, foraminal, and perivertebral venous. The frequencies and types of leakages were compared in both groups Using chi(2) and Fisher exact tests, respectively., Results: The PMMA leakage occurred in 20 (55.5%) of 36 fractures with IVCs and in 25 (51.0%) of 49 fractures without IVCs, without significant difference (P = 0.679). No patients experienced clinical complications. The leakage types that frequently occurred were intradiscal (13/20, 65.0%), perivertebral venous (5/20, 25%), epidural (1/20, 5%), and foraminal (1/20, 5%) in compression fractures with IVCs; and epidural (11/25, 44.0%), intradiscal (6/25, 24%), and perivertebral venous (8/25, 32%) in those without. A significant difference was found between the most frequent types in both groups (P = 0.006, P = 0.003, respectively). Conclusions: On CT after vertebroplasty, the incidences of PMMA leakage in osteoporotic compression fractures with and without IVCs were similar; however, leakage type frequencies differed.