Prevalence of extravertebral cement leakage after vertebroplasty: procedural documentation versus CT detection.
BACKGROUND
Reported incidence of extravertebral cement leakage after vertebroplasty varies widely across studies.


OBJECTIVE
To retrospectively compare the relative detection rates of extravertebral leakage noted under intra-procedural fluoroscopic surveillance, postprocedure plain radiographs, and postprocedure computed tomography (CT) in a cohort of patients undergoing vertebroplasty.


METHODS
With IRB approval, we retrospectively identified 181 patients with 277 levels treated with percutaneous vertebroplasty among a total of 1255 patients undergoing vertebroplasty between 1999 and 2010 who had subsequently undergone a CT examination that included the treated level(s). Categories of leakage were paravertebral, end plate, epidural, and prevertebral venous leakage. CT-detected leak rates were then compared to those noted on the vertebroplasty procedure reports and the archived fluoroscopic images for this same cohort using Pearson's χ(2) test.


RESULTS
One hundred and forty-nine (82%, 95% CI 76-87%) of 181 patients demonstrated evidence of some type of leakage on CT at one or more treated levels. Sixty-two (34%, 95% CI 28-42%) and seventy-seven (50%, 95% CI 43-57%) of 149 CT-detected leaks were reported in the procedural dictation or detected on plain radiography (P = 0.01 and 0.006, respectively). The most common type of leakage noted on CT was end plate (n = 81, 45%, 95% CI 38-52%), followed by paravertebral (n = 64, 35%, 95% CI 29-43%), epidural (n = 36, 20%, 95% CI 15-26%), and prevertebral venous (n = 32, 18%, 95% CI 13-24%).


CONCLUSIONS
Cement leakage after vertebroplasty is common and is often not reported by operators in procedural dictations. CT detects substantially more leaks than plain radiography.
College of Medicine, Mayo Clinic, Rochester, MN, USA.
Douglas J
DJ
Martin
Arash Ehteshami
AE
Rad
David F
DF
Kallmes
D000368:Aged; D001843:Bone Cements / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D015995:Prevalence; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements