Complications Of Vertebroplasty

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Kemal Yucesoy


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Citation: K. Yucesoy : Complications Of Vertebroplasty. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

Objective: The aim of this study is to evaluate the complications of percutaneous vertebroplasty in pathological fractures. Introduction: Complications related with vertebroplasty have become the subject of clinical studies with the increasing number of procedures. There can be puncture associated complications such as wrong needle path leading to fracture of the pedicle or mechanical irritation of the nerve root, pneumothorax , thecal injury and epidural bleeding. Cement leakage can also be an important complication during the procedure. Since polymethylmethacrylate is injected as liquid, micro-fractures at the margins of the vertebral bodies or filling of intraosseous veins can lead to extravasation. Methods: Vertebroplasty technique was applied on 101 patients and 122 levels with the diagnosis of vertebral fractures. Procedure was undertaken under local anesthesia with the aim of a x-arm device. Complications of the surgical procedure along with the clinical and radiological properties of the cases were evaluated. Etiological factors were secondary to trauma in 41 cases, osteoporotic compression fracture in 39, compression secondary to metastatic tumor in 16 cases, hemangioma in 3 cases and solitary plasmasytoma in 2 cases. 79 cases were treated at one level and 22 cases at 2 levels. ( 1 case of T3, 1 case of T4, 3 cases of T7, 2 cases of T8, 2 cases of T9, 5 cases of T10, 6 cases of T11, 32 cases of T12, 36 cases of L1, 15 cases of L2, 7 cases of L3 , 7 cases of L4 and 5 cases of L5). All patients were evaluated with visual analogue scores and Oswestry back pain questionnaire results. Results: The major problem experienced in our series was complications related with cement leakage. Minor leakage was detected in 25 cases; leakage into intervertebral disc space (14 cases), vascular leakage (3 cases), extravasation beneath ALL (8 cases). Major leakage was detected in 3 cases as leakage into the neural canal. We applied open surgery in all of these 3 cases. First case was belongs to our late (three hour later) procedures because of slowly progressive neurological deficit and, insufficient viewing on C-arm. She was treated with hemilaminectomy to decompress the neural structures but resulted in paraplegia. Others were operated on with a very quick manner with total laminectomy and removal of the extravasated PMMA and were all deficit-free (Figure 1). Long-term follow-up of our cases revealed that 5 cases were re-operated because of adjacent segment fractures. Four of these cases suffered from leakage into the intervertebral disc space in the first procedure. We experienced no complications related with the puncture of the needle, nor allergic reactions in our series. Conclusion: In general, PVP is quick, safe and easy but complications can be severe and should not be underestimated. Excellent fluoroscopy technique is mandatory to optimize the anatomic orientation and awareness of cement leakage or puncture associated situations. All PVP procedures must be done in operating room in order to access to the neural canal with open surgery in cases of major complications. Sedation can also be superior to general anesthesia as patients can be aware of symptoms such as radicular pain or paresthesia and can warn the clinicians for the possibility of complication.

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