Aim and object of the study. The modern spinal surgery accepts the percutaneous vertebroplasty (PV) with polymethylmethacrylate(PMMA) as routine procedure for treatment of painful osteoporotic, neoplastic and traumatic compression fractures in the thoracic and lumbar region of the spinal column. Although considered to be minimal invasive and safe procedure, it could be complicated with severe disabling and even life-threatening complications. The aim of the present study is to evaluate the different potential complications with their clinical presentation, diagnostics and different treatment options.
Methods: The study analyzes a cohort of 56 consecutive patients (66 levels) treated with PV in our clinic for the period January 2008 - July 2012. Of them 31(55,4%) are women and 25(44,6%) are men with mean age of 61,7 (23 - 80) years. The osteoporotic and traumatic compression fractures subgroup comprises of 44 (78,6%) patients, while the patients with neoplastic fractures are 12(21,4%). All the fractures are classified as A1 Magerl`s fractures with no neurologic deficit.
Results: Complications and unwanted events are registered in 9(16,1%) patients. Of them 2 experienced transient increased pain syndrome intensity, one of the patients presented with index level radiculopathy, 2 patients were diagnosed with extravertebral leakage of the cement in the spinal canal with compression of the neural structures and subsequently operated, 1 patient had cement leak in the adjacent disk, 2 patients cement leak in the paravertebral soft tissues and the paravertebral venous system and one with cement pulmonary embolism.
Conclusion: PV is minimal invasive and effective procedure that is used in the treatment of the painful osteoporotic, traumatic and neoplastic compression fractures on neurologically intact patients. The clinically significant complications and unwanted events are relatively rare encounter and in the majority of the cases are treatable with conservative measures. The epidural cement migration with neural elements compression is the only one indication for surgical decompression and removal of the compressing cement.
References:
Lieberman I. Vertebral Augmentation for Osteoporotic and Osteolytic Vertebral Compression Fractures: Vertebroplasty and Kyphoplasty Advances in Spinal Stabilization. Basel 2003;16: 240-250.
Phillips FM. Complications of Vertebroplasty and Kyphoplasty Complications of Pediatric and Adult Spinal Surgery Marcel Dekker, New York 2004:593-614.
Kostuik JP. Fractures of the cervical, thoracic, and lumbar spine. Marcel Dekker New York; 2002:635-654.
Yang S-C, Chen W-J et al. Revision strategies for complications and failure of vertebroplasties. Eur Spine J 2008;17:982–988.
Ha et al. Revision Surgery after Vertebroplasty or Kyphoplasty Clinics in Orthopedic Surgery. 2010; (2) 4:203-208.
Wu C-C, Lin M-H, Yang S-H et al. Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine. Eur Spine J 2007;16 (3):S326–S331.
McGirt MJ, Parker SL, Wolinsky J-P et al. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. The Spine Journal 2009;(9) 501–508.
Layton KF, Thielen KR, Koch CA et al. Vertebroplasty, First 1000 Levels of a Single Center: Evaluation of the Outcomes and Complications. AJNR Am J Neuroradiol.2007;28:683– 89.
Brodano GB, Amendola L, Martikos K et al. Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases. Eur Spine J 2011; 20:1265–1271.
Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166-8.
Marthis JM Percutaneous Vertebroplasty: Complication Avoidance and Technique Optimization. AJNR Am J Neuroradiol. 2003;24:1697–1706.
Tomycz ND, Gerszten PC. Minimally Invasive Treatments for Metastatic Spine Tumors: Vertebroplasty, Kyphoplasty, and Radiosurgery Neurosurg Q. 2008;18:104–108.
Teng MMH, Cheng H, No DM. Intraspinal Leakage of Bone Cement after Vertebroplasty: A Report of 3 Cases. AJNR Am J Neuroradiol 2006;27:224-29.
Christie SD. Vertebroplasty and Kyphoplasty Atlas of Neurosurgical Techniques Thieme New York 2006:866-875.
Nairn RJ, Binkhamis S, Sheikh A. Current Perspectives on Percutaneous Vertebroplasty: Current Evidence/Controversies, Patient Selection and Assessment, and Technique and Complications. Radiology Research and Practice 2011; doi:10.1155/2011/175079:1-10.
Mohit AA, Douglas O. Percutaneous Vertebral Augmentation in Pathologic Fractures. Curr Opin Orthop 2007;18:221–225.
Barragan-Campos HM, Vallee J-N et al. Complications of Vertebroplasty for Metastasis. Radiology 2006;(238)1:354-362.
Nazar A. Al-Naksabandi. Percutaneous vertebroplasty complications. Ann Saudi Med. 2011; 31(3): 294–297.
Lin EP, Ekholm S. et al.Vertebroplasty: Cement Leakage into the Disc Increases the Risk of New Fracture of Adjacent Vertebral Body.AJNR Am J Neuroradiol 2004;25:175–180.
Choe DH, Marom EM, Ahrar K et al. Pulmonary Embolism of Polymethyl Methacrylate During Percutaneous Vertebroplasty and Kyphoplasty. AJR 2004;183:1097–1102.
Lee CB, Kim HS, Kim YJ. Pyogenic Spondylitis after Vertebroplasty. Asian Spine Journal 2007; (1) 2:106-109.
Cho D-Y, Lee W-Y et al. Treatment of thoracolumbar burst fractures with polymethil methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery 2003;53:1354-1361.
Nakano M, Hirano N, Zukawa M et al. Vertebroplasty Using Calcium Phosphate Cement for Osteoporotic Vertebral Fractures: Study of Outcomes at a Minimum Follow-up of Two Years. Asian Spine Journal 2012; (6)1:34~42.
Al-Ali F, Barrow T, Luke K. Vertebroplasty: What Is Important and What Is Not. AJNR Am J Neuroradiol 2009;30:1835–39.
Hiwatashi A, Westesson P-LA. Vertebroplasty for Osteoporotic Fractures with Spinal Canal Compromise. AJNR Am J Neuroradiol.2007; 28:690 –92.
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