Background: Cement leakage remains a significant challenge in percutaneous vertebroplasty
(PVP). Leakage can lead to serious complications, including spinal cord compression,
pulmonary embolism, and nerve root irritation. While several techniques have been
proposed to minimize leakage, an effective and simple solution is still needed. This
study investigates the impact of pre-washing vertebral bodies with cold saline before
cement injection as a potential method to reduce leakage. Methods: A retrospective
analysis was conducted on patients who underwent PVP for osteoporotic vertebral compression
fractures. Patients were divided into three groups: (1) conventional PVP, (2) PVP
with room-temperature saline pre-injection, and (3) PVP with cold saline (4 degrees
C) pre-injection. Cement leakage was assessed using intraoperative fluoroscopy and
postoperative computed tomography (CT), categorized into paravertebral, intervertebral,
retrograde, spinal canal, and distant venous leakage. Statistical analysis was performed
to compare leakage rates among the groups. Results: A total of 262 patients with 461
treated vertebrae were analyzed. Cold saline pre-treatment significantly reduced cement
leakage rates compared to conventional PVP and room-temperature saline pre-injection
(p < 0.05). CT imaging detected significantly more cement extravasation than fluoroscopy
(p < 0.01). The incidence of spinal canal and intervertebral leakage was lowest in
the cold saline group, suggesting improved cement containment and distribution. Conclusions:
Pre-washing vertebral bodies with cold saline before cement injection in PVP significantly
reduces cement leakage, particularly in the spinal canal and intervertebral spaces.
This simple and cost-effective approach may enhance surgical safety and improve patient
outcomes.
