Impact of Cement Distribution Zone on Pain Relief After Unipedicular Vertebroplasty
Overview
This study analyzed 425 patients undergoing unipedicular vertebroplasty for osteoporotic vertebral compression fractures, demonstrating that the dominant intravertebral cement distribution zone strongly predicts post-procedure pain relief. Pain reduction was greatest when cement predominantly occupied Zone 4 of the vertebral body. Cement leakage was common but without permanent neurological deficits.
Background
Osteoporotic vertebral compression fractures cause significant pain and disability in older adults. Percutaneous vertebroplasty, involving injection of polymethylmethacrylate cement, is used to provide rapid pain relief and mechanical stabilization, though its effectiveness remains debated. Unipedicular vertebroplasty is increasingly favored for shorter procedure times and reduced radiation exposure but results in variable cement distribution. Understanding how cement location within the vertebral body affects outcomes may optimize procedural techniques and improve patient results.
Data Highlights
Parameter
Value
Number of patients
425
Mean preoperative VAS
7.63 ± 0.84
Mean postoperative VAS
3.31 ± 1.06
Mean change in VAS
4.32 ± 1.38
Complication rate
45.4% (primarily cement leakage)
Linear regression R²
0.724 (adjusted 0.717)
Logistic regression Nagelkerke R²
0.729
Key Findings
Dominant cement distribution zone independently predicted pain improvement, with Zone 4 associated with the greatest reduction in VAS scores (p < 0.001).
Patients with cement predominantly in Zones 1–3 had significantly lower odds of achieving a clinical response (VAS change > 4) compared to Zone 4.
Higher baseline pain (preoperative VAS) and greater cement volume also independently predicted better pain relief.
Complications occurred in 45.4% of patients, mainly cement leakage, but no permanent neurological deficits were reported.
The four-zone classification system provided a simple, reproducible method to assess cement distribution relevant to clinical outcomes.
Clinical Implications
Assessing the dominant cement distribution zone during unipedicular vertebroplasty can guide procedural quality and predict pain relief outcomes. Targeting cement placement toward Zone 4 may optimize analgesic benefit without increasing serious complications. Incorporating cement distribution assessment into routine practice could improve patient selection and procedural planning.
Conclusion
Dominant intravertebral cement distribution zone is a strong, independent predictor of pain improvement following unipedicular vertebroplasty. This simple classification may serve as a practical quality marker to enhance procedural outcomes.
Related Resources & Content
Impact of Predominant Cement Distribution Area on Post-Procedure Pain Relief Following Unipedicular Percutaneous Vertebroplasty, 2024
