Dorsolumbar Vertebroplasty- A Retrospective Study

Abstract

Introduction: Percutaneous Vertebroplasty (PVP) is a procedure frequently performed to obtain pain relief and mechanical strengthening of the collapsed vertebral body which may be caused by variant reasons. Aim: To assess frequent complications commonly encountered during vertebroplasty procedure. Materials and Methods: A retrospective study was conducted on 1375 patients followed from January 2005 and June 2012 in Department of Neurosurgery, faculty of medicine, Dokuz Eylül University. Severe vertebral fracture collapse (vertebra plana), vertebral metastasis, quadriplegic patients and bed-ridden patients were excluded from this study, whereas active mobile patients without associated severe co-morbidities were included in the study. Pain, pattern of cement leakage and associated complications had been assessed. Results: Total 601 patients who fullfilled the inclusion criteria {244 (40.5%) males, 357 (59.5%) females}, average age was 63.04±7.4 (range 34 to 90) years, had undergone the PVP procedure. Mean preoperative Visual Analog Scale (VAS) was 8.51±1.5, whereas after one and six months, the mean postoperative VAS were 1.94±1.0 and 2.53±2.2, respectively. Central spinal canal leakage has been observed in four cases. Three patients had developed transient monoparesis and radiculopathy symptoms. Whereas, the fourth patient developed paraplegia. Cement leakage had been tolerated well by one patient, where symptomatic resolution occurred within one month. However, decompressive foraminotomy had been performed for two patients on the 24th and 38thdays postoperatively due to intractable radicular pain. Immediate total laminectomy and decompression surgery had been performed for removal of the cement leakage to the spinal canal for the patient who developed total paraplegia. Asymptomatic leakage had been recognised beneath the posterior longitudinal ligament in 42 patients (6.9%), beneath the anterior longitudinal ligament in 18 patients (2.9%) and into disc space in 31 patients (5.1%). Venous leakage occurred in four patients (0.6%) and was asymptomatic in all of them. Conclusion: Vertebroplasty should be performed in a fully equipped operation theater in order to be able to revert quickly to open surgery in case of cement leakage into the spinal canal.