Cement leakage in percutaneous vertebroplasty: effect of preinjection gelfoam embolization.
METHODS
Prospective case series.


OBJECTIVE
To determine the safety and feasibility of routine preinjection of gelfoam embolization during percutaneous vertebroplasty.


BACKGROUND
Percutaneous vertebroplasty has been used effectively in pain relief for vertebral fractures resulting from malignancy and osteoporosis. However, cement extrusion is a common problem and can lead to complications. Gelfoam embolization of venous channels before cement injection has not been widely used as a technique to prevent leakage.


METHODS
Thirty-one patients who met the inclusion-exclusion criteria for the study underwent percutaneous vertebroplasty. Venography was first performed to determine the flow pattern in the vertebrae and confirm needle placement. Next, routine gelfoam embolization of venous channels was performed. This was followed by low-pressure, minimal-volume cement injection. The outcome measure of cement leakage was assessed after surgery using radiographs and CT scans.


RESULTS
There were no complications. In the 31 patients, 61 levels of vertebroplasty were performed. Overall, there were 16 leaks out of 61 levels in 12 patients (26.2%). In osteoporotic fractures, there were 11 leaks in 49 levels, giving a leakage rate of 22.5%. There was only 1 epidural leak in this group (2%), and this was asymptomatic. Seven leakages were into the adjacent disc, 2 into the body, and 1 into the paravertebral tissues. In malignant fractures, there were 5 leakages out of 12 levels (41.7%). Of these, 2 were epidural leaks (16.7%), which were asymptomatic.


CONCLUSIONS
Complications resulting from leakage are the most feared side effect of the procedure. This has resulted in only limited application of vertebroplasty in the United Kingdom. Routine gelfoam embolization together with careful technique has been shown to be a safe and feasible method during vertebroplasty.
Bhatia
Chandra
C
Department of Orthopaedics, University Hospital of North Tees, Hardwick, Stockton on Tees, UK.
Barzilay
Yair
Y
Krishna
Manoj
M
Friesem
Tai
T
Pollock
Raymond
R
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods*
D001843:Bone Cements