Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the "cooling system".
METHODS
During vertebroplasty (VP), polymethylmethacrylate (PMMA) may leak into the posterior epidural venus plexus, provoking symptoms ranging from radicular pain to medullar compression.


OBJECTIVE
To propose and test the feasibility of a procedure (cooling system) to prevent radicular irritation caused by foraminal PMMA leakage.


BACKGROUND
Foraminal leak of PMMA, as observed during VP, may lead to radiculalgia. Several mechanisms of nerve root irritation have been proposed. Considering heat or local chemical irritation has led us to treat immediately by local periradicular irrigation with a cooling liquid.


METHODS
Four consecutive patients with observed foraminal leakage were treated by local fluid injection. Immediately after observation of a foraminal leak, a 20-gauge Chiba needle was positioned to reach the foramen. Ten cubic centimeters of lidocaine (0.2%) was followed by 100-200 cc of pressurized saline perfusion within 10-20 minutes (cooling system).


RESULTS
In all patients with foraminal leakage, no radicular pain existed after application of the cooling system. No complications were observed with its use.


CONCLUSIONS
In presence of a foraminal leakage, the immediate application of a cooling irrigation may protect the root from injury, which is explained by the hypothesis that the main mechanism of injury may be more related to heat or chemical irritation of the nerve than compression.
Kelekis
Alexis D
AD
Department of Radiology and Neuroradiology, Geneva University Hospital, Geneva, Switzerland. Alexis.Kelekis@hcuge.ch
Martin
Jean-Baptiste
JB
Somon
Thierry
T
Wetzel
Stephan G
SG
Dietrich
Pierre-Yves
PY
Ruefenacht
Daniel A
DA
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D001843:Bone Cements / Q000009:adverse effects; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D019904:Polymethyl Methacrylate / Q000009:adverse effects; D011843:Radiculopathy / Q000139:chemically induced / Q000517:prevention & control*; D012965:Sodium Chloride / Q000008:administration & dosage; D013126:Spinal Nerve Roots / Q000187:drug effects / Q000503:physiopathology
D000779:Anesthetics, Local; D001843:Bone Cements; D012965:Sodium Chloride; D019904:Polymethyl Methacrylate; D008012:Lidocaine