The Potential Impact of Venobasillar System Morphology and Applied Technique on Epidural Cement Leakage with Percutaneous Vertebroplasty

Abstract

Background: Bone cement leakage during vertebroplasty is a frequently reported complication with the potential for neural injury. Objective: To assess risk factors for epidural cement leakage during vertebroplasty. Setting: Neurosurgical department of a scientific research institute. Study Design: This is a prospective cross-sectional randomized trial. Methods: Seventy-five patients with intractable pain due to low energy vertebral compression fractures between T11 and L5 were treated with vertebroplasty at 150 vertebral levels. Preoperative computed tomography (CT) scans were utilized to characterize vertebral parameters including the type of nutrient foramena in the posterior vertebral cortex. Following vertebroplasty, distance from the needle tracts to the midline and the presence and type of any epidural cement leakage were determined. Using logistic regression analysis, significant risk factors for cement leakage were determined. Results: A smaller distance between the tip of the needle and the midline and a magistral type of venobasillar system were found to be significant risk factors for epidural cement leakage (P < 0.0001). Use of a bipedicular vs. monopedicular technique did not significantly affect the rate of epidural cement leakage (P = 0.3869). Limitations: This study is limited because of the relatively small number of patients and the lack of any patients who had clinical consequences as a result of extensive epidural cement leakage. Conclusion: The type of venobasillar system should be taken into account when planning a vertebroplasty procedure as a magistral type of venobasillar system is associated with the increased rate of epidural cement leakage. It is important to try and achieve a large distance between the needle tip and the midline, especially when a magistral type of venobasillar system is present, to reduce the risk of epidural cement leakage. Key words: Vertebroplasty, intracanal cement leakage, low energy vertebra fracture