Efficacy of mixed bone cement (PMMA/CPC) versus PMMA in treatment of osteoporotic vertebral compression fractures

Abstract

Objective To compare the efficacy of percutaneous vertebroplasty (PVP) using polymethyl methacrylate (PMMA)/calcium phosphate cement (CPC) (1∶1) and PMMA alone for osteoporotic vertebral compression fractures (OVCFs). Methods A retrospective case-control study was conducted in 69 OVCFs patients with whole clinical data of 2 year's follow-up undergoing PVP in our department between January and August 2018. Thirty-six patients received PMMA/CPC (mixed group) and 33 patients PMMA alone (PMMA group). The general and perioperative data, clinical efficacy [visual analog scale (VAS) and Oswestry disability index (ODI)], postoperative complications (cement leakage and incidence of adjacent vertebral fracture within 2 years after operation) and postoperative radiological data (anterior vertebral height and Cobb angle) were compared between the 2 groups. Results The operations were successful among all the patients, and no severe complications or kyphosis occurred. There were no significant differences in age, gender, bone density, distribution of fracture vertebral body, operation time, volume of bleeding, and injection volume of bone cement between the mixed and PMMA groups. The pain VAS score and ODI score were decreased significantly in both groups after operation (P < 0.05), and no differences were seen in the scores at each time point between them. The PMMA group had much higher in the incidence of adjacent vertebral failure than the mixed group (30.3% vs 11.1%, P=0.048) during the follow-up. The mixed group had significantly higher incidences of cement leakage (27.8% vs 15.1%), though no statistical difference (P=0.204). The follow-up CT scanning also found that mixed fillers were partially absorbed by bone tissue in the vertebral body. Conclusion Mixed bone cement PMMA/CPC is safe and effective in PVP treatment for OVCFs, and shows better performance in reducing the occurrence of adjacent vertebral fractures than PMMA alone.

Keywords

• mixed bone cement
• polymethyl methacrylate
• calcium phosphate cement
• precutaneous vertebroplasty
• osteoporotic vertebral compression fractures