Complication Of Percutaneous Vertebroplasty Research Articles

Incidence and risk factors of adjacent vertebral fracture after percutaneous vertebroplasty or kyphoplasty in postmenopausal women: a retrospective study

Adjacent vertebral fracture (AVF) is a serious complication of percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). This study aimed to explore the incidence and risk factors of AVF following PVP or PKP in postmenopausal women. The incidence of AVF was determined by spinal radiographic examinations. The potential risk factors of AVF were identified by univariate analysis, followed by multivariate logistic regression analyses to determine the independent risk factors. In total, 674 postmenopausal women who were treated with PVP or PKP from December 2019 to February 2022 were enrolled in the study. Among them, 58 (8.61%) women experienced an AVF following PVP or PKP. After adjusting for confounding factors, BMI (OR [95% CI] 0.863 [0.781–0.952]; p = 0.003), previous history of OVCF (OR [95% CI] 1.931 [1.044–3.571]; p = 0.036), and Hounsfield unit (HU) value (OR [95% CI] 0.979 [0.967–0.990]; p < 0.001) were found to be independent risk factors of AVF following PVP or PKP in postmenopausal women. The ROC analysis revealed that the BMI and HU thresholds were 21.43 and 65.15, respectively. In conclusion, the incidence of AVF was 8.61%. BMI, previous history of OVCF and HU value were independent risk factors of AVF following PVP or PKP in postmenopausal women.

Development of patient-tailored preoperative assessment of percutaneous vertebroplasty.

Percutaneous vertebroplasty (PVP), a minimally invasive surgery technique, has become the common treatment for osteoporotic vertebral compression fractures (OVCF). The complications of PVP will lead to severe damage to spinal neuro systems due to bone cement leakage. A patient tailored preoperative assessment approach was developed to reduce the risks of complications in this study. The porcine OVCF model was fabricated to mimic the patient vertebral fracture in vitro using decalcification process. The 3D reconstructed model based on the imagological examination data acquired from the porcine vertebral bone was implemented for finite element (FE) simulation. The vertebral body with bone cement injected was scanned using CT for comparison with the finite element simulation results. This study showed a practical method for predicting the flow of bone cement in OVCF, which enabled the surgeons to evaluate the bone cement flow during preoperative assessment to reduce the cement leakage risks.

Complications of Percutaneous Vertebroplasty: A Pictorial Review.

Percutaneous vertebroplasty is a minimally invasive treatment technique for vertebral body compression fractures. The complications associated with this technique can be categorized into mild, moderate, and severe. Among these, the most prevalent complication is cement leakage, which may insert into the epidural, intradiscal, foraminal, and paravertebral regions, and even the venous system. The occurrence of a postprocedural infection carries a notable risk which is inherent to any percutaneous procedure. While the majority of these complications manifest without symptoms, they can potentially lead to severe outcomes. This review aims to consolidate the various complications linked to vertebroplasty, drawing from the experiences of a single medical center.

Cement pulmonary embolism as a complication of percutaneous vertebroplasty in a patient with follicular lymphoma

Vertebroplasty involves injecting a cement polymer, often polymethylmethacrylate (PMA), into the vertebral body under imaging guidance to increase stability. However, the high vascularization and anatomical network of the paravertebral and extradural venous plexuses can allow the migration of cement particles into the systemic venous circulation regardless of whether spinal compression or fractures occur during or are present prior to the treatment. This case report presents a 42-year-old female patient who visited the emergency room with symptoms of cough, nasal obstruction, rhinorrhea, and dyspnea and had a history of follicular non-Hodgkin’s lymphoma under rituximab treatment. Imaging revealed a cement embolism in the pulmonary artery tree, most likely caused by prior vertebroplasty. Anticoagulation was started despite the lack of hypoxemia due to the inorganic character of the embolic substance and the patient’s immunosuppressed status. The embolic debris was still present on subsequent imaging, but the patient’s condition remained stable, with some signs of illness remission. This case highlights the importance of considering cement embolism as a possible vertebroplasty complication and the importance of properly assessing and managing such cases, particularly in patients with underlying medical issues, as well as the need for the development of a standard protocol of sequential chest X-rays after the procedure and possible alternatives to PMA.

Cement pulmonary embolism as a complication of percutaneous vertebroplasty

Percutaneous Vertebroplasty (PV) involves the injection of Poly Methylmeth Acrylate (PMA) Bone Cement (BC) into the vertebral body

Complications of Percutaneous Vertebroplasty

Complications of Percutaneous Vertebroplasty

Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors.

The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors. This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach. The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean=41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%. Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method. Level IV, Therapeutic Study.

Chest Pain From an Unusual Cause: Intracardiac Leaked Bone Cement After Percutaneous Vertebroplasty.

Percutaneous vertebroplasty (PV) is a common procedure performed to treat vertebral compression fractures in patients nonresponsive to conservative management (1). PV is a relatively simple and minimally invasive procedure in which polymethylmethacrylate (PMMA), also known as bone cement, is injected into the collapsed vertebra for pain control and stabilization of the vertebral body (2). Even though PV is considered a relatively safe procedure, life-threatening complications can occur. Cement leakage remains the most common and serious complication of PV, with a reported frequency of 30–75.1% (3).

Selections of Bone Cement Viscosity and Volume in Percutaneous Vertebroplasty: A Retrospective Cohort Study

We sought to evaluate the efficacy and complications of percutaneous vertebroplasty with different viscosities and volumes of bone cement in treating osteoporotic vertebral compression fractures (OVCFs). We conducted a retrospective cohort study of 307 patients treated for a single thoracolumbar level (T12-L2) OVCF in our hospital between January 2014 and December 2019. The patients were divided into 6 groups according to different viscosities (I: low-viscosity bone cement, II: high-viscosity bone cement) and injection volumes (A, 2-4 mL; B, 4-6 mL; C, 6-8 mL) of bone cement. Clinical and radiologic characteristics including visual analog scale, local kyphotic angle, anterior vertebral height ratio, cement leakage, and vertebral body recollapse rate were collected preoperatively, 2 days postoperation, and at the last follow-up to assess the efficacy and complications of each group. Regarding efficacy, there was no significant difference between the 2 kinds of bone cement. Injecting >4 mL of cement can provide patients with good improvements of clinical indicators and a low vertebral body recollapse rate. Injecting 6-8 mL of bone cement slightly improved the radiologic indicators. However, the leakage rate of low-viscosity bone cement increased significantly when the volume exceeded 6 mL. The leakage rate of high-viscosity bone cement did not increase significantly at the volume of 6-8 mL. In summary, when treating single thoracolumbar level OVCFs, the recommended volume of low-viscosity bone cement is 4-6 mL while the optimal volume of high-viscosity bone cement is 6-8 mL.

FATAL CENTRAL PULMONARY CEMENT EMBOLISM AFTER KYPHOPLASTY

SESSION TITLE: Case Report Semifinalists 8 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: A 61-year old male presented to the emergency department with progressive shortness of breath two days after a kyphoplasty of T11-L1 due to a T12 fracture. The immediate post-operative course was uneventful. No post-procedure imaging was ordered and the patient was discharged to a rehabilitation center the day after surgery. CASE PRESENTATION: Vital signs showed a heart rate of 108 beats per minute, blood pressure of 130/87 mmHg, and temperature of 101 degrees Fahrenheit. Physical exam demonstrated a patient in respiratory distress with decreased breath sounds and crackles bilaterally on auscultation. Arterial blood gas demonstrated severe hypoxemia. An abdominal CT incidentally confirmed large polymethymethacrylate (PMMA) bone cement embolisms in both main pulmonary arteries and in a vertebral vein anterior to T11. He soon became obtunded with rapidly progressive hemodynamic and respiratory failure, was intubated and transferred to the intensive care unit. Despite all resuscitation efforts, he went into refractory shock necessitating vasopressors. Due to the ongoing progression of cardiac and hypoxemic respiratory failure and scarcity of therapeutic options, the patient was transferred to a hospital with a cardiothoracic surgery team for possible extra corporeal membrane oxygenation (ECMO) or surgical pulmonary artery embolectomy. After a safe transfer, the patient went into cardiopulmonary arrest while being evaluated and expired before he could benefit from any procedure. DISCUSSION: Pulmonary cement embolisms (PCE) are a complication of percutaneous vertebroplasty (PV) and balloon kyphoplasty procedures. In both procedures PMMA is injected into the body of the vertebra, either directly (vertebroplasty) or within an inflated balloon (kyphoplasty). Cement can leak into the vertebral vein, continue to the inferior vena cava and reach the pulmonary arteries. Fatalities due to PCE remain extremely rare, relate to PV, and occur during the procedure (3,6) or a few days after (7,8). Our case is, to our knowledge, the first fatality occurring in a kyphoplasty patient. CONCLUSIONS: No standardized treatment exists for PCE but many interventions are possible to retrieve larger emboli before they can become life threatening, if they are identified immediately (1,2,4,5). Additional studies should be conducted to identify patients at risk and avoid this occurrence. In the meantime, it seems reasonable to infer from past cases and our personal experience that routine intra-operative identification of leakages with fluoroscopy and post-operative CXR may be helpful in rapid recognition and treatment of this patient population before they become symptomatic and irreversibly hemodynamically unstable. Reference #1: 1. Barbero, S, et al. “Percutaneous Vertebroplasty: the Follow-up.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Feb. 2008, www.ncbi.nlm.nih.gov/pubmed/18338131. Reference #2: 2. Baumann, A. et al. Cement Embolization into the Vena Cava and Pulmonal Arteries After Vertebroplasty: Interdisciplinary Management. European Journal of Vascular and Endovascular Surgery, Volume 31 , Issue 5 , 558 - 561 3. Chen, H L, et al. “A Lethal Pulmonary Embolism during Percutaneous Vertebroplasty.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Oct. 2002, www.ncbi.nlm.nih.gov/pubmed/12351294/. 4. François, K, et al. “Successful Management of a Large Pulmonary Cement Embolus after Percutaneous Vertebroplasty: a Case Report.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 15 Oct. 2003, www.ncbi.nlm.nih.gov/pubmed/14560098. Reference #3: 5. Li, Z, et al. “Cement Embolus Trapped in the Inferior Vena Cava Filter during Percutaneous Vertebroplasty.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2013, www.ncbi.nlm.nih.gov/pubmed/23690712. 6. Monticelli, F, et al. “Fatal Pulmonary Cement Embolism Following Percutaneous Vertebroplasty (PVP).” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 20 Apr. 2005, www.ncbi.nlm.nih.gov/pubmed/15734107/. 7. Stricker, K, et al. “Severe Hypercapnia Due to Pulmonary Embolism of Polymethylmethacrylate during Vertebroplasty.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Apr. 2004, www.ncbi.nlm.nih.gov/pubmed/15041623/. 8. Yoo, K Y, et al. “Acute Respiratory Distress Syndrome Associated with Pulmonary Cement Embolism Following Percutaneous Vertebroplasty with Polymethylmethacrylate.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 15 July 2004, www.ncbi.nlm.nih.gov/pubmed/15247590/. DISCLOSURES: No relevant relationships by Mariam Abboud, source=Web Response No relevant relationships by Brooke McDonald, source=Web Response

Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients

BackgroundVertebroplasty is a minimally invasive procedure commonly performed for vertebral compression fractures secondary to osteoporosis or malignancy. Leakage of bone cement into the paravertebral venous system and cement pulmonary embolism (cPE) are well described, mostly in patients with osteoporosis. Little is known about the clinical sequelae and outcomes in cancer patients. In this study, we report our experience with cPE following vertebroplasty performed in cancer patients.MethodsRecords of all consecutive cancer patients who underwent vertebroplasty at our institution were retrospectively reviewed. The procedure was performed via percutaneous injection of barium-opacified polymethyl-methacrylate cement.ResultsA total of 102 cancer patients with a median age of 53 (19–83) years were included. Seventy-eight (76.5%) patients had malignant vertebral fractures, and 24 (23.5%) patients had osteoporotic fractures. Cement PE was detected in 13 (12.7%) patients; 10 (76.9%) patients had malignant fractures, and the remaining three had osteoporotic fractures. Cement PE was mostly asymptomatic; however, 5 (38.5%) patients had respiratory symptoms that led to the diagnosis. Only the five symptomatic patients were anticoagulated.Cement PE was more common with multiple myeloma (MM); it occurred in 7 (18.9%) of the 37 patients with MM compared with only three (7.3%) of the 41 patients with other malignancies. No difference in incidence was observed between patients with osteoporotic or malignant vertebral fractures.ConclusionsCement PE is a relatively common complication following vertebroplasty and is mostly asymptomatic. Multiple myeloma is associated with the highest risk. Large-scale prospective studies can help identify risk factors and clinical outcomes and could lead to better prevention and therapeutic strategies.

Acute nontraumatic subdural intracranial hematoma: rare complication of percutaneous vertebroplasty

The paper describes a rare case of acute intracranial subdural hematoma in a 22-year old woman followed by fluoroscopy-guided percutaneous vertebroplasty for vertebral hemangioma. Percutaneous vertebroplasty was performed in usual manner on prone position. The next day a female patient complained of headache, nausea and vomiting. MRI images revealed subdural hematoma compressing the brain. Intracranial vascular abnormalities and coagulopathies associated with subdural intracranial hematoma were not evident on CT-angiography and in laboratory tests. Craniotomy was performed to remove the subdural hematoma, and the patient fully recovered. Percutaneous vertebroplasty was emphasized to be followed by rare intracranial complications, awareness of which is very important for the surgeon for complications prevention and treatment outcomes improvement.

Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients.

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient—with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.

Mismatched Perfusion Defects Secondary to Recent Methyl Methacrylate Embolization

Methyl methacrylate (MMA) pulmonary embolism is a serious potential complication of percutaneous vertebroplasty. We present a case of a 28-year-old man who presented to an outside institution with pleuritic chest pain after MMA vertebroplasty of the T11 thoracic vertebra for chronic back ache secondary to a previous traumatic fracture. Multifocal MMA pulmonary embolism was identified on CT. The patient was referred to our institution following a wedge resection for pulmonary infarction. V/Q scintigraphy was performed and demonstrated normal ventilation with multiple mismatched perfusion defects bilaterally. Patient subsequently underwent central and bilateral segmental pulmonary embolectomies.

Percutaneous vertebroplasty: Multi-centric results from EVEREST experience in large cohort of patients

PurposeThe purpose of this study was to prospectively evaluate results and complications of percutaneous vertebroplasty (PV) performed in 6 different Italian Centres belonging to the European VErtebroplasty RESearch Team (E.VE.RES.T) in a large series of patients. Materials and methodsFollow-up was obtained in 4547 patients (3211 females and 1336 males; mean age 70.2years) that underwent PV for a total of 13.437 treated vertebrae. Procedures were performed by using fluoroscopic guidance or combined CT-fluoroscopic guidance. All patients underwent PV in local anaesthesia except for second cervical vertebrae treated with a trans-oral approach that required general anaesthesia. Results4004 out of 4547 (88.0%) patients reported significant pain relief (difference>or=2 point in pain evaluated with an 11-point visual analogue scale; p<0.0001) within 48h: an average of 7.7±0.4 dropped to 1.8±0.6 in the osteoporotic patients; 8.3±0.4 to 2.4±0.4 in metastases; 8.3±0.4 to 1.7±1.0 in myeloma; 6.2±3.5 to 0.3±0.2 in angioma and 7.4±0.4 to 1.4±0.9 in trauma. 430 osteoporotic patients (13%) were retreated for a subsequent fracture; in 302/430 patients (70.2%), the new fracture occurred in the contiguous vertebra. No major neurologic complications were reported and the most frequent minor complication was venous leakage (20.5%). ConclusionsThis large series of patients confirms that percutaneous vertebroplasty is an effective and safe procedure in the treatment of vertebral fractures. Best results are obtained in the treatment of myeloma and trauma.

The importance of percutaneous vertebroplasty and radiation therapy for pathological vertebral compression fractures secondary to multiple myeloma

It is with great interest that we read the article by Chen et al. ‘‘Percutaneous vertebroplasty for pathological vertebral compression fractures secondary to multiple myeloma’’, published in the 2012 June issue of Archives of Orthopaedic and Trauma Surgery [1]. This is a thoughtful and well-designed retrospective article which evaluated the safety and complication of percutaneous vertebroplasty in the vertebral compression fractures resulting from multiple myeloma. The authors conclude that vertebroplasty remains the best option for pain relief and is effective in increasing the quality of life. They corroborate that radiation therapy needs to be performed in conjunction with vertebroplasty for malignant spinal disease, because cement injection alone does not prevent tumor growth. The article also suggested that vertebroplasty should be performed before radiation therapy, because the analgesic effects of the former are immediate and spinal stability is addressed [1]. The viewpoint of the author is right, but we have some disagreement and a few points need to be discussed with more detail. Nowadays, percutaneous vertebroplasty is a valid therapeutic option in the management of severe back pain caused by vertebral compression fractures. It is a minimally invasive, radiologically guided interventional procedure, which involves the injection of polymethylmethacrylate (PMMA) into the fractured vertebral body [2]. As we know, vertebroplasty and radiation therapy are complementary procedures to patients with pathological vertebral compression fractures; ideally, vertebroplasty immediately stabilizes the spine and relieves pain within hours, and the tumor can be further treated with radiation therapy [3–5]. The authors suggested using vertebroplasty prior to radiation therapy because the analgesic effects of the former are immediate and spinal stability is addressed. In our opinion, the important reason is that radiation therapy can lead to hardening of the bone, making the vertebroplasty more difficult to perform [6, 7]. Another reason is that malignant tissue is compressed and relocated to subcortical areas in vertebroplasty, which support local control by radiation therapy later [8]. The authors also suggested that cement injection alone cannot prevent tumor growth. In our opinion, PMMA cement has an antitumoral effect and could treat the underlying tumor cells within the affected vertebral body. This effect may be the result of the cytotoxicity, thermal effects, and ischemia produced by PMMA cement. When injected into the involved vertebral body, the space-occupying effect will inhibit tumor cell growth. More importantly, vascular structures, which are indispensable for underlying tumor cells to growth, are destroyed by the considerable exothermic reaction of the implant during its polymerization, chemical and toxic effects of the monomer, compressive effects on small nerves, and ischemic phenomena subsequent to PMMA impregnation into small vessels [9, 10]. In summary, to patients with pathological vertebral compression fractures secondary to multiple myeloma, we H. Zhao Q. Shi Z.-Y. Sun Q.-L. Gu L. Ni H.-L. Yang (&) Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 188 Shizi St., Suzhou 215006, Jiangsu, China e-mail: soochowspine@139.com

Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty

Percutaneous vertebroplasty (PVP) with polymethylmethacrylate (PMMA) is a minimally invasive procedure that provides significant pain relief in a high percentage of patients with osteoporotic fractures. The complication rate of PVP is reported to be below 6%. This case illustrates, for the first time, an arterial PMMA embolus to the aorta and its branches as a complication of PVP.

Percutaneous vertebroplasty for pathological vertebral compression fractures secondary to multiple myeloma

Vertebral compression fractures are common in multiple myeloma. Percutaneous vertebroplasty is used to stabilize vertebral collapse and treat the pain. The major technical drawbacks of percutaneous vertebroplasty are the potential for neural comprise and pulmonary embolism of cement from leakage of polymethylmethacrylate into epidural space and perivertebral veins. We have retrospectively evaluated the safety and complication of percutaneous vertebroplasty in the vertebral compression fractures resulting from multiple myeloma. From August 2003 to July 2008, we describe 24 patients with multiple myeloma who were treated for vertebral compression fractures with percutaneous vertebroplasty to a total of 36 vertebrae. There were 4 male and 20 female patients with an average age of 67 (range 54–81 years). The pain symptoms were measured on a visual analog pain scale and quality of life as measured by the physical component summary scale of the Short Form- 36 before operation and at 24 h, at 3 months and at 1 year following vertebroplasty. Radiography was reviewed for evidence of cement leakage and pulmonary complication. The mean visual analog pain scale decreased from a preoperative value of 9.0–3.8 at 24 h following operation and SF-36 score improved from 22.1 to 41.8. Of the twenty-four patients, four had cement leakage (2 leak through inferior endplate into disc, 2 leak into perivertebral vessels). There were no intra-postoperative neurologic or pulmonary complications. Eight patients died 2–18 months post-operatively due to multiple myeloma-related organ failure. In this study, vertebroplasty significantly improved pain scores and function and, thereby, the quality of life. There were no major procedure-related complications in this study. Direct cytotoxic effect, polymerization and biomechanical microfractures stabilizer of polymethylmethacrylate play multiple roles in pain relief. In multiple myeloma, when pathological spinal compression fractures cause intractable pain and are unresponsive to conservative treatment, vertebroplasty remains the best option for pain relief and is effective in increasing quality of life.

Lumbar artery pseudoaneurysm after percutaneous vertebroplasty: a unique vascular complication

Complications from percutaneous vertebroplasty (PV) and kyphoplasty are rare and are most commonly related to cement leakage. Pseudoaneurysm of the segmental arteries has not been reported as a complication of PV in the literature. In this article, the authors describe 2 patients who presented with a lumbar pseudoaneurysm after undergoing PV at other institutions. The authors also review the optimal technique to avoid such vascular complications.

Complications of Percutaneous Vertebroplasty

Aim Percutaneous vertebroplasty is a safe and effective treatment for patients with severe back pain induced by osteoporotic or neoplastic compression fractures. Although this is a minimally invasive procedure, complications have been reported. Migration of polymethylmethacrylate is the most important complication. Methods and Materials During a 5-year period, 28 patients (13 men and 15 women mean age 61.7 y) underwent fluoroscopy-guided percutaneous vertebroplasty procedures to treat 30 vertebrae. Vertebroplasty was carried out in 73.7% vertebrae with osteoporotic compression fractures. Results Half of patients had no leakage, 23.3% of patients had disk space leakage, 20% of patients epidural and foraminal leakage, and 6.7% of patients had venous epidural leaks. There were no deaths or delayed complications. Mean Visual Analogue Scale before treatment was 76.5±8.72 and after treatment was 21.3±1.07, that means vertebroplasty significantly relief the pain. Four patients had radicular pain that completely resolved with rest and conservative treatment. Conclusions Percutaneous vertebroplasty may have major complications, such as a cement leakage into the epidural spaces, even when carried out by experienced spinal surgeons. Despite the cement leakage percutaneous vertebroplasty-induced complications were rare.