Leakage of cement following vertebroplasty may cause problems for the patient. Hiwatashi et al identified risk factors for cement leakage that can be identified in a magnetic resonance imaging (MRI) study performed prior to the procedure. The authors are from the University of Rochester, Kyushu University, Showa University and Osaka University.


Patient selection: osteoporotic compression fracture with indications for vertebroplasty


Cement leakage is associated with vertebral body fracture in the adjacent vertebra. It may also exert mechanical forces on the intervertebral disk.


Risk factors for cement leakage associated with preoperative MRI imaging:

(1) cortical defect at the compression fracture

(2) abnormal hyperintense T2 signal in the adjacent intervertebral disk space

(3) absence of an intravertebral cleft



• A compression that is more comminuted is more likely to leak cement.

• A cortical defect is a discontinuity of cortical hypointensity on sagittal T2-weighted or fat-suppresed, contrast-enhanced T1-weighted images.

• An adjacent disk space that had a signal on T2-weight images higher than that seen in normal-appearing disk spaces was considered hyperintense.

• An intravertebral cleft was an abnormal T2 hyperintensity similar to cerebrospinal fluid (CSF).

• An intravertebral cleft may indicate fracture nonunion.


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