title: Neurologic deficit following percutaneous vertebral stabilization.
abstract: METHODS
  A retrospective review.
  
  
  OBJECTIVE
  The purpose of this study is to document a series of cases of neurologic deficit following percutaneous vertebral stabilization, to identify patterns of neurologic injury, and to describe potential methods for avoiding these injuries.
  
  
  BACKGROUND
  Percutaneous vertebral stabilization procedures, including vertebroplasty and kyphoplasty, have become a widely used for the treatment of osteoporotic vertebral compression fractures, primary and metastatic vertebral tumors, and traumatic burst fractures. Despite an increasing array of indications, there have been few reports of adverse events. Neurologic complications associated with vertebroplasty and kyphoplasty have been described previously as case reports and have generally been considered as infrequent and minor in severity.
  
  
  METHODS
  The clinical course of 14 patients with documented loss of neurologic function following percutaneous vertebral cement augmentation was retrospectively reviewed.
  
  
  RESULTS
  The average patient age was 74.9 years (range, 46-88 years) with 3 male and 11 female patients. Four patients underwent a vertebroplasty procedure while 10 were treated with kyphoplasty. Six patients developed neurologic deficits acutely (<24 hours of procedure). The remaining 8 patients developed neurologic symptoms at an average of 37.1 days (range, 3-112 days) postprocedure. Neurologic deficits were recorded as ASIA A in 4 patients, ASIA B in 2 patients, ASIA C in 1 patient, and ASIA D in 7 patients. Twelve of 14 patients (85.7%) required revision open surgical intervention for treatment of their neurologic injury.
  
  
  CONCLUSIONS
  Percutaneous vertebroplasty and kyphoplasty have been reported to be safe options for the treatment of painful osteoporotic vertebral fractures. Although complications are infrequent, there remains the potential for catastrophic neurologic injury. Physicians performing these procedures need to be aware of these potential complications and be prepared to respond in an emergent manner (surgically) if a need arises.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA. alpesh2@gmail.com
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Gregg G
authors.initials: GG
authors.lastname: Martyak
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Steven C
authors.initials: SC
authors.lastname: Ludwig
authors.forename: Jim A
authors.initials: JA
authors.lastname: Youssef
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Gelb
authors.forename: Hallett H
authors.initials: HH
authors.lastname: Mathews
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Edward H
authors.initials: EH
authors.lastname: Chung
authors.forename: Gregory
authors.initials: G
authors.lastname: Grabowski
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Kuklo
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D011312:Pressure / Q000009:adverse effects; D011843:Radiculopathy / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D013117:Spinal Cord Compression / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D016103:Spinal Fractures / Q000139:chemically induced / Q000188:drug therapy* / Q000601:surgery*; D013130:Spinal Stenosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
chemical_list: D019904:Polymethyl Methacrylate