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Vertebroplasty is one of the newest surgical approaches for the treatment of the osteoporotic spine. Recent studies have shown that it is a minimally invasive, safe, promising procedure for patients with osteoporotic fractures while providing structural reinforcement of the osteoporotic vertebrae as well as immediate pain relief. However, treatment failures due to excessive bone cement injection have been reported as one of complications. It is believed that control of bone cement volume seems to be one of the most critical factors in preventing complications. We believed that an optimal bone cement volume could be assessed based on CT data of a patient. Gray-level run length analysis was used to extract textural information of the trabecular. At initial stage of the project, four indices were used to represent the textural information: mean width of intertrabecular space, mean width of trabecular, area of intertrabecular space, and area of trabecular. Finally, the area of intertrabecular space was selected as a parameter to estimate an optimal bone cement volume and it was found that there was a strong linear relationship between these 2 variables (correlation coefficient = 0.9433, standard deviation = 0.0246). In this study, we examined several factors affecting overall procedures. The threshold level, the radius of rolling ball and the size of region of interest were selected for the sensitivity analysis. As the level of threshold varied with 9, 10, and 11, the correlation coefficient varied from 0.9123 to 0.9534. As the radius of rolling ball varied with 45, 50, and 55, the correlation coefficient varied from 0.9265 to 0.9730. As the size of region of interest varied with 58 x 58, 64 x 64, and 70 x 70, the correlation coefficient varied from 0.9685 to 0.9468. Finally, we found that strong correlation between actual bone cement volume (Y) and the area (X) of the intertrabecular space calculated from the binary image and the linear equation Y = 0.001722 X - 2.10922. We could see that this equation slightly overestimated bone cement volume and those amounts would not make any serious complications. We hope this will help to control a proper amount of bone cement volume injection during vertebroplasty.
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