Complications of percutaneous vertebroplasty and their prevention.
Vertebroplasty is an efficient treatment of vertebral collapses of malignant or benign origin but also carries a risk of complications. Cement extravasation is a frequent occurrence in vertebroplasty. It is well tolerated in the large majority of cases but is also the main source of complications especially nerve root compression in case of cement leakage into the intervertebral foramen and pulmonary embolism of cement complicating venous cement leakage. Rate of these complications are much higher in malignant than in osteoporotic collapses. The risk of neurological complication also increases at the cervical level. In addition, incidence of new vertebral fractures in adjacent vertebrae may be increased by vertebroplasty. General reactions possibly due to a reflex reaction to intramedullary bone injection and fat embolism may also occur. This article reviews the safety measures to reduce the risk of cement extravasation including high quality permanent radiological guidance enabling early detection of cement extravasation, use of conscious sedation, bilateral transpedicular approach at the thoracic and lumbar levels, careful selection of the bone penetration site in order to make a single vertebral needle path, careful needle placement to avoid the risk of cortical breakthrough, use of a well-opacified and refrigerated cement with a toothpaste consistency.
Laredo
Jean-Denis
JD
Hopital Lariboisière, Service de Radiologie Ostéo-Articulaire, 2, rue Ambroise-Paré, 75475 Paris 10, France. jean-denis.laredo@lrb.ap-hop-paris.fr
Hamze
Bassam
B
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000601:surgery*; D001843:Bone Cements / Q000009:adverse effects* / Q000627:therapeutic use; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005598:Fractures, Spontaneous / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D008297:Male; D020366:Methylmethacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009408:Nerve Compression Syndromes / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D015641:Radiography, Interventional; D016103:Spinal Fractures / Q000601:surgery*; D013126:Spinal Nerve Roots; D013131:Spine / Q000601:surgery*
D001843:Bone Cements; D020366:Methylmethacrylate