Surgical complications and unwated events in the modern percutaneous vertebroplasty treatment

Abstract

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.