AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026020014
Submit to EJMO
Cite this article
3
Download
28
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL RESEARCH ARTICLE

Postoperative complications of vertebral augmentation for osteoporotic vertebral compression fractures: A multicenter descriptive clinical and imaging study

Xiaoming Zhao1 ,  Yingang Zhang1 ,  Jun Gao2*
Show Less
1 Department of Orthopedics, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
2 Department of Orthopedics, Xi’an Fengcheng Hospital, Xi’an, Shaanxi, China
EJMO, 026020014 https://doi.org/10.36922/EJMO026020014
Received: 8 January 2026 | Revised: 31 January 2026 | Accepted: 5 February 2026 | Published online: 11 March 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
XML
Cite
Abstract

Introduction: Osteoporotic vertebral compression fractures (OVCFs) are a major source of pain and disability in older adults. Percutaneous vertebroplasty and kyphoplasty stabilize the fractured vertebra and often provide rapid analgesia, yet procedure-related events remain clinically relevant. In particular, the behavior of polymethyl methacrylate (PMMA) cement—leakage, endplate breach, and nonuniform fill—can be underrecognized without targeted imaging follow-up. Such characterization may guide safer injection technique and postoperative surveillance strategies.

Objective: This study aims to evaluate the incidence and imaging characteristics of postoperative complications after vertebral augmentation in patients with OVCFs and to provide hypothesis-generating clinical imaging observations.

Methods: Clinical and imaging data from patients with OVCFs who underwent percutaneous vertebroplasty or percutaneous kyphoplasty at three medical centers between 2023 and 2025 were retrospectively reviewed. A single commercial lowviscosity PMMA cement product was used intraoperatively for all patients. The types and incidence of complications during postoperative follow-up were systematically recorded, and descriptive analyses were performed alongside imaging findings.

Results: Among 102 patients (154 treated vertebrae; ≥12-month follow-up), 41 developed postoperative complications. Cement-related findings were frequent: leakage in 11 patients (10.78%), uneven intravertebral distribution in 8, cement penetration through the endplate into the intervertebral disc in 5, and aseptic loosening or displacement in 7. Six patients had adjacent vertebral refractures and two had other adverse events. Most complications caused no severe neurological dysfunction and improved with symptomatic treatment. Imaging follow-up revealed recurring patterns of location and morphology across complication categories.

Conclusion: Postoperative complications after vertebral augmentation for OVCFs were heterogeneous, with cement-related imaging findings being relatively common. This descriptive observational imaging series summarizes these patterns and situates them within prior literature on PMMA behavior, generating hypotheses for future prospective, quantitative, and biomechanical investigations.

Keywords
Osteoporotic vertebral compression fractures
Vertebral augmentation
Polymethyl methacrylate
Bone cement
Complications
Funding
This study was funded by the National Natural Science Foundation of China (No. 81371987 to Yingang Zhang) and the Shaanxi Province Key Research and Development Project (No. 2023-YBSF-341 to Xiaoming Zhao).
Conflict of interest
The authors declare that they have no commercial or financial relationships that could be perceived as a potential conflict of interest.
References
  1. Moschovaki-Zeiger O, Zini C, Marcia S, Filippiadis DK, Gangi A, Cazzato RL. ESR Essentials: Vertebral augmentation for osteoporotic fractures-practice recommendations by the Cardiovascular and Interventional Radiological Society of Europe. Eur Radiol. 2025:1-8. doi: 10.1007/s00330-025-12119-6

 

  1. Ghandour M, Mert Ü, Pishnamaz M, et al. Refracture and Mortality Following Surgical Management of Osteoporotic Vertebral Fractures: A Systematic Review and Meta- Analysis with Patient-Level Survival Modeling. J Clin Med. 2025;14(22):8230. doi: 10.3390/jcm14228230

 

  1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005- 2025. J Bone Miner Res. 2007;22(3):465-475. doi: 10.1359/jbmr.061113

 

  1. Alimy A, Anastasilakis AD, Carey JJ, et al. Conservative Treatments in the Management of Acute Painful Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2024;7(9):e2432041. doi: 10.1001/jamanetworkopen.2024.32041

 

  1. Zhang Y, Ge J, Liu H, et al. Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta- analysis. Eur Spine J. 2024;33(4):1490-1497. doi: 10.1007/s00586-023-08032-5

 

  1. Tai TW, Tsai YL, Shih CA, et al. Refracture risk and all- cause mortality after vertebral fragility fractures: Anti- osteoporotic medications matter. J Formos Med Assoc. 2023;122(suppl 1):S65-S73. doi: 10.1016/j.jfma.2023.04.004

 

  1. Láinez Ramos-Bossini AJ, Garrido Sanz F, Gea Becerra M, et al. Efficacy of Percutaneous Vertebroplasty Versus Placebo and Conservative Treatment in Osteoporotic Vertebral Fractures: An Updated Systematic Review and Meta- Analysis of Randomized Clinical Trials. Diagnostics (Basel). 2025;15(21):2684. doi: 10.3390/diagnostics15212684

 

  1. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568. doi: 10.1056/NEJMoa0900429

 

  1. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569-579. doi: 10.1056/NEJMoa0900563

 

  1. Quan Q, Gongping X, Ruisi N, Shiwen L. New Research Progress of Modified Bone Cement Applied to Vertebroplasty. World Neurosurg. 2023;176:10-18. doi: 10.1016/j.wneu.2023.04.048

 

  1. You Z, Wu K, Jiang Y, Chen J. Effect of vertebral kyphoplasty versus vertebroplasty on pain and indicators of imaging parameters of the injured vertebrae in patients with osteoporotic vertebral compression fractures: a meta- analysis. J Orthop Surg Res. 2025;20(1):199. doi: 10.1186/s13018-025-05621-6

 

  1. Mohammadi SS, Phull SS, Bal BS, Towler MR. Bone void filler materials for augmentation in comminuted fractures: a comprehensive review. J Orthop Surg Res. 2025;20(1):449. doi: 10.1186/s13018-025-05857-2

 

  1. Rose LD, Bateman G, Ahmed A. Clinical significance of cement leakage in kyphoplasty and vertebroplasty: a systematic review. Eur Spine J. 2024;33(4):1484-1489. doi: 10.1007/s00586-023-08026-3

 

  1. Essibayi MA, Mortezaei A, Azzam AY, et al. Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials. Eur Radiol. 2024;34(11):7185-7196. doi: 10.1007/s00330-024-10807-3

 

  1. Korovessis P, Syrimpeis V, Korovesis A, Dimakopoulos G. Incidence of new osteoporotic adjacent vertebral body fractures. A comparison between conservative treatment and vertebral  body  augmentation  (vertebroplasty, kyphoplasty): a systematic review and meta-analysis. Front Surg. 2025;12:1594217. doi: 10.3389/fsurg.2025.1594217

 

  1. Cheng Y, Cheng X, Wu H. Risk factors of new vertebral compression fracture after percutaneous vertebroplasty or percutaneous    Front  Endocrinol. 2022;13:964578. doi: 10.3389/fendo.2022.964578

 

  1. et al. Layered Double Hydroxide Modified Bone Cement Promoting Osseointegration via Multiple Osteogenic Signal Pathways. ACS Nano. doi: 10.1021/acsnano.1c00461

 

  1. Kim MJ, Park SY, Kang S, et al. Low modulus PMMA-based bone cement for the reduction of adjacent vertebral fractures after vertebroplasty. Acta Biomater. 2025;203:399-411. doi: 10.1016/j.actbio.2025.07.053

 

  1. Xie S, Cui L, Wang C, et al. Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically. Spine J. 2025;25(2):324-336. doi: 10.1016/j.spinee.2024.09.021

 

  1. Meng H, Li Q, Lin J, Yang Y, Fei Q. Intradiscal cement leakage (ICL) increases the stress on adjacent vertebrae after kyphoplasty for osteoporotic vertebra compression fracture (OVCF): a finite-element study. Sci Rep. 2023;13(1):15984. doi: 10.1038/s41598-023-43375-5

 

  1. Ren H, Feng T, Cao J, et al. A Retrospective Study to Evaluate the Effect of Dynamic Fracture Mobility on Cement Leakage in Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in 286 Patients with Osteoporotic Vertebral Compression Fractures. Med Sci Monit. 2022;28:e935080. doi: 10.12659/MSM.935080

 

  1. Wang Q, Sun C, Zhang L, et al. High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis. Eur Spine J. 2022;31(5):1122-1130. doi: 10.1007/s00586-022-07150-w

 

  1. Seesala VS, Sheikh L, Basu B, Mukherjee S. Mechanical and Bioactive Properties of PMMA Bone Cement: A Review. ACS Biomater Sci Eng. 2024;10(10):5939-5959. doi: 10.1021/acsbiomaterials.4c00779

 

  1. Tang B, Xu S, Chen X, et al. The impact of intravertebral cleft on cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a case-control study. BMC Musculoskelet Disord. 2021;22(1):805. doi: 10.1186/s12891-021-04685-9

 

  1. Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Orthop Surg. 2023;15(10):2492-2504. doi: 10.1111/os.13800

 

  1. Sa Y, Yang F, Wang Y, Wolke JGC, Jansen JA. Modifications of Poly(Methyl Methacrylate) Cement for Application in Orthopedic Surgery. In: Chun H, Park C, Kwon I, Khang G, eds. Cutting-Edge Enabling Technologies for Regenerative Medicine. Springer; 2018;1078:119-134. doi: 10.1007/978-981-13-0950-2_7

 

  1. He Q, Chen H, Huang L, et al. Porous surface modified bioactive bone cement for enhanced bone bonding. PLoS One. 2012;7(8):e42525. doi: 10.1371/journal.pone.0042525

 

  1. Karpiński R, Szabelski J. Mechanical Properties and Functional Assessment of PMMA Bone Cements Modified with Glassy Carbon. J Funct Biomater. 2025;16(7):254. doi: 10.3390/jfb16070254

 

  1. Zhao X, Gao J, Han H, et al. Bioactive strong biodegradable bone cement for rapid osteointegration and osteogenesis. Chem Eng J. 2023;474:145609. doi: 10.1016/j.cej.2023.145609

 

  1. Wang Z, Luo S, Yang L, et al. Intelligent and Bioactive Osseointegration of the Implanted Piezoelectric Bone Cement with the Host Bone Is Realized by Biomechanical Energy. ACS Appl Mater Interfaces. 2024;16(16):20157- 20168. doi: 10.1021/acsami.4c00632

 

  1. Xie S, Cui L, Wang C, et al. Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically. Spine J. 2025;25(2):324-336. doi: 10.1016/j.spinee.2024.09.021

 

  1. Shin JW, Kim DH, Kang KM, et al. Biomechanical Effects of Cement Augmentation and Prophylactic Vertebroplasty on Adjacent Segment Stability in Multilevel Spinal Fusion: A Finite Element Analysis. Bioengineering (Basel). 2025;12(10):1071. doi: 10.3390/bioengineering12101071

 

  1. Zhou C, Meng X, Huang S, et al. Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis. Heliyon. 2024;10(5):e26726. doi: 10.1016/j.heliyon.2024.e26726

 

  1. Zhang Z, Zhang J, He B, Dong Q, Hao D. Effect of bone cement distribution on adjacent disc degeneration after vertebral augmentation for osteoporotic vertebral compression fractures in aging patients. Front Surg. 2023;10:1256401. doi: 10.3389/fsurg.2023.1256401

 

  1. He L, Li W, Zhai X, Li Z. Risk factors for adjacent vertebral fracture after kyphoplasty or percutaneous vertebroplasty in osteoporotic vertebral systematic review and meta-analysis compression fractures. Eur Spine J. 2025;34(11):5126-5141. doi: 10.1007/s00586-025-09111-5

 

  1. Tanvir MAH, Khaleque MA, Kim GH, Park SE, Lee HH, Kim YY. Low-Temperature Spine-Specific PMMA Enhances Bone Regeneration via Localized Thermal Necrosis in an Osteoporotic Rat Model. Int J Mol Sci. 2025;26(10):4786. doi: 10.3390/ijms26104786

 

  1. Ramanathan S, Lin YC, Thirumurugan S, et al. Poly(methyl methacrylate) in orthopedics: strategies, challenges, and prospects in bone tissue engineering. Polymers. 2024;16(3):367. doi: 10.3390/polym16030367

 

  1. Opalko M, Bösebeck H, Vogt S. Properties and clinical application safety of antibiotic-loaded bone cement in kyphoplasty. J Orthop Surg Res. 2019;14(1):238. doi: 10.1186/s13018-019-1200-3

 

  1. Ullah I, Ju J, Song Y, et al. PMMA bone cement with AgNP@CDs nanocomposite for infection control and inflammation mitigation. Regen Biomater. 2025;12:rbaf086. doi: 10.1093/rb/rbaf086

 

  1. He H, Liu Y, Dong Y, et al. Material properties and progress in modification of hydrogel-based self-expandable PMMA bone cement. RSC Adv. 2025;15(33):26959-26980. doi: 10.1039/d5ra00592b
Next article in this issue
Share
Back to top
Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept