Vertebroplasty: techniques to avoid complications.
BACKGROUND
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).


OBJECTIVE
The authors present methods, equipment, and principles that minimize occurrence of PMMA migration and other complications.


METHODS
Patients in a private/university neurosurgery practice were studied retrospectively by chart review.


METHODS
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.


METHODS
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.


CONCLUSIONS
Although vertebroplasty is considered a minimally invasive procedure, it can result in serious complications even without technical misadventures.
Buffalo Neurosurgery Group, 555 Orchard Park Road, Suite A105, West Seneca, NY 14224, USA. bng@buffnet.net
D B
DB
Moreland
M K
MK
Landi
W
W
Grand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods*; D010024:Osteoporosis / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013131:Spine / Q000601:surgery