Neurologic deficit following percutaneous vertebral stabilization.
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.
Patel
Alpesh A
AA
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA. alpesh2@gmail.com
Vaccaro
Alexander R
AR
Martyak
Gregg G
GG
Harrop
James S
JS
Albert
Todd J
TJ
Ludwig
Steven C
SC
Youssef
Jim A
JA
Gelb
Daniel E
DE
Mathews
Hallett H
HH
Chapman
Jens R
JR
Chung
Edward H
EH
Grabowski
Gregory
G
Kuklo
Timothy R
TR
Hilibrand
Alan S
AS
Anderson
D Greg
DG
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
D019904:Polymethyl Methacrylate