Retrospective Analysis of Cement Extravasation Rates in Vertebroplasty, Kyphoplasty, and Bone Tumor Radiofrequency Ablation

<b>Background:</b> Percutaneous vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and bone tumor radiofrequency ablation (BT-RFA), are commonly used to treat painful vertebral compression fractures (VCFs). While generally safe and effective, they carry risks, including cement extravasation, which can lead to pulmonary embolism or spinal cord compression. This study aims to compare the rate of cement extravasation across different vertebral augmentation techniques and identify potential risk factors. <b>Methods:</b> A retrospective cohort study was conducted at a comprehensive cancer center on 1002 procedure encounters in 888 patients who underwent vertebral augmentation for painful VCFs. Data were collected on patient demographics, fracture pathology, procedure type, imaging guidance, and pain scores. Intraoperative and postoperative imaging were manually reviewed to assess cement extravasation. Statistical analyses were performed using pairwise comparisons with Tukey's Honest Significant Difference adjustment to compare cement extravasation rates across the procedure groups and generalized linear mixed models to assess the association between the cement extravasation with other variables. <b>Results</b>: Cement extravasation occurred in 573 (57.2%) encounters. Kyphoplasty had the lowest rate of cement extravasation (46.2%) with significantly lower odds compared to vertebroplasty (OR: 0.42, 95% CI: 0.30-0.58; <i>p</i> < 0.0001) and BT-RFA (OR: 0.57, 95% CI: 0.42-0.77; <i>p</i> = 0.0009). Pathologic fractures and multilevel augmentations were linked to a 64% (<i>p</i> = 0.001) and 63% (<i>p</i> = 0.0003) increased odds of cement extravasation, respectively. Male sex and older age were protective factors. <b>Conclusions:</b> Cement extravasation is a common but largely asymptomatic complication of percutaneous vertebral augmentation. It is crucial to consider patient-specific risk factors when selecting an augmentation technique to optimize outcomes. Kyphoplasty may be the optimal choice for patients at increased risk of cement extravasation.