[General Spine] The major complications of transpedicular vertebroplasty: a review

[Justin]

Journal of Neurosurgery: Spine. Nov 2009, Vol. 11, No. 5, Pages 607-613

The major complications of transpedicular vertebroplasty: a review

Murat Cosar, M.D.1, Mehdi Sasani, M.D.2, Tunc Oktenoglu, M.D.2, Tuncay Kaner, M.D.3, Omur Ercelen, M.D.4, K. Cagri Kose, M.D.5, and A. Fahir Ozer, M.D.2. 1Department of Neurosurgery, Faculty of Medicine, Canakkale 18 March University, Canakkale; 2Departments of Neurosurgery and 4Anesthesiology, VKV American Hospital, Istanbul; 3Department of Neurosurgery, Pendik State Hospital, Istanbul; and 5Department of Orthopedics, Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey. Abbreviations used in this paper: SDH = subdural hematoma; VB = vertebral body. ©1944-2009 by the American Association of Neurosurgeons

Object
Vertebroplasty is a well-known technique used to treat pain associated with vertebral compression fractures. Despite a success rate of up to 90% in different series, the procedure is often associated with major complications such as cord and root compression, epidural and subdural hematomas (SDHs), and pulmonary emboli, as well as other minor complications. In this study, the authors discuss the major complications of transpedicular vertebroplasty and their clinical implications during the postoperative course.

Methods
Vertebroplasty was performed in 12 vertebrae of 7 patients. Five patients had osteoporotic compression fractures, 1 had tumoral compression fractures, and 1 had a traumatic fracture. Two patients had foraminal leakage, 1 had epidural leakage, 1 had subdural cement leakage, 2 had a spinal SDH, and the last had a split fracture after the procedure.

Results
Three patients had paraparesis (2 had SDHs and 1 had epidural cement leakage), 3 had root symptoms, and 1 had lower back pain. Two of the 3 patients with paraparesis recovered after evacuation of the SDH and subdural cement; however, 1 patient with paraparesis did not recover after epidural cement leakage, despite cement evacuation. Two patients with foraminal leakage and 1 with subdural cement leakage had root symptoms and recovered after evacuation and conservative treatment. The patient with the split fracture had no neurological symptoms and recovered with conservative treatment.

Conclusions
Transpedicular vertebroplasty may have major complications, such as a spinal SDH and/or cement leakage into the epidural and subdural spaces, even when performed by experienced spinal surgeons. Early diagnosis with CT and intervention may prevent worsening of these complications.

complication; spine; epidural cement leakage; subdural cement leakage; subdural hematoma; vertebroplasty.

[No pain is gain]

Journal of Neurosurgery: Spine. Nov 2009, Vol. 11, No. 5, Pages 607-613

The major complications of transpedicular vertebroplasty: a review

Murat Cosar, M.D.1, Mehdi Sasani, M.D.2, Tunc Oktenoglu, M.D.2, Tuncay Kaner, M.D.3, Omur Ercelen, M.D.4, K. Cagri Kose, M.D.5, and A. Fahir Ozer, M.D.2. 1Department of Neurosurgery, Faculty of Medicine, Canakkale 18 March University, Canakkale; 2Departments of Neurosurgery and 4Anesthesiology, VKV American Hospital, Istanbul; 3Department of Neurosurgery, Pendik State Hospital, Istanbul; and 5Department of Orthopedics, Faculty of Medicine, Kocatepe University, Afyonkarahisar, Turkey. Abbreviations used in this paper: SDH = subdural hematoma; VB = vertebral body. ©1944-2009 by the American Association of Neurosurgeons

Object
Vertebroplasty is a well-known technique used to treat pain associated with vertebral compression fractures. Despite a success rate of up to 90% in different series, the procedure is often associated with major complications such as cord and root compression, epidural and subdural hematomas (SDHs), and pulmonary emboli, as well as other minor complications. In this study, the authors discuss the major complications of transpedicular vertebroplasty and their clinical implications during the postoperative course.

Methods
Vertebroplasty was performed in 12 vertebrae of 7 patients. Five patients had osteoporotic compression fractures, 1 had tumoral compression fractures, and 1 had a traumatic fracture. Two patients had foraminal leakage, 1 had epidural leakage, 1 had subdural cement leakage, 2 had a spinal SDH, and the last had a split fracture after the procedure.

Results
Three patients had paraparesis (2 had SDHs and 1 had epidural cement leakage), 3 had root symptoms, and 1 had lower back pain. Two of the 3 patients with paraparesis recovered after evacuation of the SDH and subdural cement; however, 1 patient with paraparesis did not recover after epidural cement leakage, despite cement evacuation. Two patients with foraminal leakage and 1 with subdural cement leakage had root symptoms and recovered after evacuation and conservative treatment. The patient with the split fracture had no neurological symptoms and recovered with conservative treatment.

Conclusions
Transpedicular vertebroplasty may have major complications, such as a spinal SDH and/or cement leakage into the epidural and subdural spaces, even when performed by experienced spinal surgeons. Early diagnosis with CT and intervention may prevent worsening of these complications.

complication; spine; epidural cement leakage; subdural cement leakage; subdural hematoma; vertebroplasty.

great article. surprisingly out of 7, only 1 was "messed up" by anesthesiologist, 2 by orthopod and 4 by neurosurgeons.