Abstract: BACKGROUND: With the aging of the population, the incidence of osteoporosis is increasing year by year, and osteoporotic spinal fracture, as one of the common complications, brings great pain and inconvenience to patients. As an effective treatment, percutaneous vertebroplasty has been widely used in clinical practice. However, cement leakage as a potential risk of this procedure has been the focus of researchers.
OBJECTIVE: To investigate the causes and management strategies of cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. 
METHODS: A total of 100 osteoporotic vertebral compression fractures patients who underwent percutaneous vertebroplasty in the Department of Orthopedics of Beijing Pinggu District Hospital from March 2017 to February 2021 were selected as the study subjects. According to the 12-month follow-up results, the patients were divided into bone cement leakage group (n=27) and non-bone cement leakage group (n=73). Cox proportional risk regression analysis was used to screen the influencing factors of bone cement leakage after surgery, so as to construct and evaluate the nomogram model for predicting the risk of bone cement leakage after surgery. Visual analog scale score and Oswesry dysfunction index of 27 patients were observed before surgery, 3 days and 12 months after surgery following bone cement leakage treatment.
RESULTS AND CONCLUSION: (1) Among the 27 patients with bone cement leakage, 24 patients had internal leakage of intervertebral disc endplate, no obvious symptoms or discomfort, and no special treatment. Pulmonary embolism occurred in 1 case, and the patient was treated with the help of respiratory department. Two patients with symptoms underwent percutaneous intervertebral foramen endoscopic bone cement removal. (2) CT value, fracture severity, bone cement viscosity, cortical fracture, and injection amount of bone cement were the independent influencing factors for postoperative bone cement leakage (P < 0.05). (3) The calibration degree and differentiation degree of the nomogram model were good, and it had good clinical practicability. (4) For 27 patients with external bone cement leakage after surgery, visual analog scale score at 3 days and 12 months after surgery was significantly lower than that before surgery, and the difference was statistically significant (P < 0.05). Oswesry dysfunction index score at 12 months after surgery was significantly lower than that at 3 days after surgery, and the difference was statistically significant (P < 0.05). (5) The results show that the amount of bone cement injection, bone cement viscosity, cortical fracture, CT value, and fracture severity are the risk factors of bone cement leakage after percutaneous vertebroplasty.

Key words: osteoporotic vertebral compression fracture, osteoporosis, percutaneous vertebroplasty, bone cement leakage, cause analysis