Abstract: BACKGROUND: Although studies have shown that symmetrical distribution of bone cement can reduce postoperative vertebral refractures and help improve prognosis. However, achieving better bone cement distribution during percutaneous vertebroplasty remains an important issue for surgeons.
OBJECTIVE: To explore the effect of cement distribution on the efficacy of unilateral percutaneous vertebroplasty to provide effective preventive and therapeutic measures to prevent postoperative vertebral fracture.
METHODS: The 193 patients who underwent unilateral percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were selected and divided into group I (bone cement not touching the upper and distal end plates; n=59), group II (bone cement only touching the upper or lower end plate; n=80), and group III (bone cement touching both the upper and distal end plates; n=54). Basic data, operation-related indicators, including operation time, total hospital cost, postoperative hospital time, cement injection, visual analog scale and Oswestry disability index scores of low back pain, postoperative vertebral height recovery rate, local kyphosis angle, incidence of injured vertebral body and adjacent vertebrae were compared among the three groups. Follow-up results of all patients were recorded.
RESULTS AND CONCLUSION: (1) In group III, the visual analog scale and Oswestry disability index scores were significantly lower than those in groups I and II, and the difference was statistically significant (P < 0.05). (2) The incidence of injured vertebral refracture and incidence of total vertebral fractures in groups I and II were significantly higher than that in group III, and the differences were all statistically significant (P < 0.05). (3) There were no significant differences in other indicators of patients of the three groups, such as bone cement leakage, Oswestry disability index, and visual analog scale score at 1 week, 1 month after surgery, and during last follow-up, postoperative vertebral height recovery rate, local kyphosis angle, operation time, total hospital cost, and postoperative hospital stay (P > 0.05). (4) It is indicated that compared with groups I and II, patients of group III get better long-term prognosis, and bone cement touching both the upper and distal end plates can significantly reduce the incidence of injured vertebral and total vertebral fractures. Surgeons should fully grasp the diffusion of bone cement, and develop targeted prevention and treatment strategies, so as to reduce the risk of further fracture in the future.

Key words: osteoporotic vertebralcompression fracture, percutaneous vertebroplasty, bone cement, bone cement diffusion, vertebral refracture