Frontiers in surgery · 2026
Effect of dominant cement distribution zone on pain relief after unipedicular percutaneous vertebroplasty.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Yay Murat Özcan, Çetiner Melih
Аннотация
BACKGROUND: Cement location within the vertebral body may influence pain relief after unipedicular vertebroplasty. We tested a simple four-zone classification of dominant intravertebral cement distribution in osteoporotic vertebral compression fractures.
METHODS: We retrospectively analyzed 425 patients treated from 2021 to 2024. On postoperative imaging, the vertebral body was divided into four equal zones (Zones 1-4) and the zone with the greatest cement accumulation was recorded. Pain was measured with the visual analog scale (VAS) before and after the procedure; change in VAS was the primary endpoint. Multivariable linear regression modeled change in VAS. Logistic regression modeled clinical response (change in VAS > 4).
RESULTS: Mean VAS decreased from 7.63 ± 0.84 to 3.31 ± 1.06 (p < 0.001), with mean change in VAS of 4.32 ± 1.38. Change in VAS differed across zones (p < 0.001), highest in Zone 4 and lowest in Zone 1. Complications occurred in 45.4% (primarily cement leakage) without permanent neurological deficit. In linear regression, dominant zone independently predicted change in VAS (B = 0.852; standardized β = 0.546; p < 0.001) and overall fit was strong (R² = 0.724; adjusted R² = 0.717). In logistic regression (n = 387), Omnibus χ² = 280.646 (df = 13, p < 0.001) and Nagelkerke R² = 0.729; zone, preoperative VAS, and cement volume were independent predictors. Calibration was acceptable (Hosmer-Lemeshow p = 0.941). Compared with Zone 4, Zones 1-3 showed lower odds of response; higher baseline VAS increased the odds.
CONCLUSIONS: Dominant cement zone strongly predicts pain improvement after unipedicular vertebroplasty and may serve as a practical procedural quality marker.
METHODS: We retrospectively analyzed 425 patients treated from 2021 to 2024. On postoperative imaging, the vertebral body was divided into four equal zones (Zones 1-4) and the zone with the greatest cement accumulation was recorded. Pain was measured with the visual analog scale (VAS) before and after the procedure; change in VAS was the primary endpoint. Multivariable linear regression modeled change in VAS. Logistic regression modeled clinical response (change in VAS > 4).
RESULTS: Mean VAS decreased from 7.63 ± 0.84 to 3.31 ± 1.06 (p < 0.001), with mean change in VAS of 4.32 ± 1.38. Change in VAS differed across zones (p < 0.001), highest in Zone 4 and lowest in Zone 1. Complications occurred in 45.4% (primarily cement leakage) without permanent neurological deficit. In linear regression, dominant zone independently predicted change in VAS (B = 0.852; standardized β = 0.546; p < 0.001) and overall fit was strong (R² = 0.724; adjusted R² = 0.717). In logistic regression (n = 387), Omnibus χ² = 280.646 (df = 13, p < 0.001) and Nagelkerke R² = 0.729; zone, preoperative VAS, and cement volume were independent predictors. Calibration was acceptable (Hosmer-Lemeshow p = 0.941). Compared with Zone 4, Zones 1-3 showed lower odds of response; higher baseline VAS increased the odds.
CONCLUSIONS: Dominant cement zone strongly predicts pain improvement after unipedicular vertebroplasty and may serve as a practical procedural quality marker.