Vertebroplasty: techniques to avoid complications

Abstract

Background context: The use of vertebroplasty for treatment of spinal fractures and spinal hemangiomas is increasing at a rapid pace. Although this is a minimally invasive procedure, complications have been reported. The most important of these is the unintentional migration of polymethylmethacrylate (PMMA). Purpose: The authors present methods, equipment, and principles that minimize occurrence of PMMA migration and other complications. Study design/setting: Patients in a private/university neurosurgery practice were studied retrospectively by chart review. Patient sample: During a 3-year period, 53 levels of vertebroplasty were performed on 35 patients presenting with indications of intractable pain resulting from vertebral body compression fractures. Outcome measures: Pain assessment and outcome determination were made by the treating physician based on dialog with the patient, examination, and the patient's use of narcotics. The medical records of patients were reviewed for these factors as well as for signs of cerebrospinal fluid leak, PMMA migration, new radiculopathy, myelopathy, new fracture, pulmonary emboli, infection, or bleeding. Methods: Criteria for inclusion consisted of disabling back pain corresponding to a recent fracture, pharmacotherapy, and medically stable for anesthesia. Vertebroplasty patients were followed up at 2 to 3 weeks and at 3 months after their procedure. Results: Success rate for relief of pain was 89%. The overall complication rate was 6% per treated vertebral level. There were no deaths or delayed complications. Factors that reduce complications were identified and include the following: accurate needle placement, adequate barium radio-opacification of PMMA, viscous low pressure delivery of PMMA, and PMMA delivery under direct fluoroscopic visualization. Conclusion: Although vertebroplasty is considered a minimally invasive procedure, it can result in serious complications even without technical misadventures.