Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty

Ming-Kai Hsieh,Ping-Yeh Chiu,Fu-Cheng Kao,Tsung-Ting Tsai,Lih-Huei Chen,Chi-Chien Niu,Chia-Wei Yu,Po-Liang Lai

doi:10.1186/s13018-019-1459-4

Abstract

BackgroundThe risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated.MethodsThree thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded.ResultsType-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support.ConclusionsCement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.

Highlights

The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated
Patients We retrospectively reviewed the records of 3175 patients treated with PVP for symptomatic Osteoporotic vertebral compression fracture (OVCF) at our institution between 2001 and 2011
Parameters related to imaging and technical characteristics, including the amount of bone cement injected per procedure, the vertebral level of the fracture, surgical approach, filling pattern, and any leakage of cement, which was classified into three types [25], as follows: B, via the basivertebral vein; S, via the segmental vein; and C, through a cortical defect, were recorded

Summary

Introduction

The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated. Percutaneous vertebroplasty (PVP) has gained widespread acceptance and is implemented broadly, mainly as a treatment method for painful OVCFs [2,3,4,5,6]. Its. The complication rate of PVP is low, and has been reported to be 1.6% to 3.8% in meta-analyses [13, 14]. Severe complications of PVP are rare; they are restricted to case reports and mainly comprise sequelae of. The rate of occurrence of cement leakage itself appears to vary, with reported incidences ranging from less than 5% to more than 80% [21,22,23,24]. When assessed using computed tomography (CT) scanning, which is known to be substantially superior to intraoperative fluoroscopy or postoperative radiography for detection of cement leakage [24, 25], the incidence of leakage was found to be 63% to 87% [21,22,23,24,25]

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Conclusion