A Classification System for the Spread of Polymethyl Methacrylate in Vertebral Bodies Treated with Vertebral Augmentation
Sakata, Michael P.
Hennemeyer, Charles T.
AffiliationCollege of Medicine, University of Arizona College of Medicine
Department of Biomedical Engineering, University of Arizona College of Engineering
Department of Medical Imaging, University of Arizona College of Medicine
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CitationA Classification System for the Spread of Polymethyl Methacrylate in Vertebral Bodies Treated with Vertebral Augmentation 2016, 2 (3):197 Tomography
Rights© 2016 The Authors. Published by Grapho Publications, LLC This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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AbstractIn this study, we develop a classification system for describing polymethyl methacrylate (PMMA) spread in vertebral bodies after kyphoplasty or vertebroplasty for vertebral compression fractures (VCFs) and for assessing whether PMMA spread varies between operators, VCF etiology, or vertebral level. Intraoperative fluoroscopic images of 198 vertebral levels were reviewed in 137 patients (women, 84; men, 53; mean age, 75.8 +/- 12.5; and those with a diagnosis of osteoporosis, 63%) treated with kyphoplasty between January 01, 2015 and May 31, 2015 at a single center to create a 5-class descriptive system. PMMA spread patterns in the same images were then classified by 2 board-certified radiologists, and a third board-certified radiologist resolved conflicts. A total of 2 primary PMMA spread patterns were identified, namely, acinar and globular, with subtypes of localized acinar, diffuse globular, and mixed, to describe an equal combination of patterns. Interrater reliability using the system was moderate (kappa = 0.47). After resolving conflicts, the most common spread class was globular (n = 63), followed by mixed (n = 58), diffuse globular (n = 30), acinar (n = 27), and localized acinar (n = 20). The spread class after treatment by the 2 most frequent operators differed significantly (n(1) = 63, n(2) = 70; P <.0001). There was no difference in the spread class between VCF etiologies or vertebral levels. PMMA spread may, therefore, be a modifiable parameter that affects kyphoplasty and vertebroplasty efficacy and adverse events.
VersionFinal accepted manuscript
SponsorsNHLBI NIH HHS [T35 HL007479]
Except where otherwise noted, this item's license is described as © 2016 The Authors. Published by Grapho Publications, LLC This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).