Vertebroplasty and Kyphoplasty: Techniques for Avoiding
The purpose of this article is to present a series of common complications and pitfalls associated with vertebroplasty and kyphoplasty, with discussions on how to avoid those problems in a practical, case-based essay.
Complication rates for vertebroplasty and kyphoplasty have been reported to range from less than 2% for osteoporotic VCFs to up to 10% for malignant tumor–related VCFs. The complications have included radiculopathy, paralysis, worsening pain, pulmonary emboli, bleeding, infection, and rib fractures. The potential for pneumothorax is always present whenever physicians work in the thoracic region. New VCFs adjacent to those that have already been treated have been implicated, particularly when large amounts of cement have leaked into the adjacent disc spaces. This supposition has been somewhat difficult to validate, however.
Many of the complications of vertebroplasty are directly related to cement leaks. In that regard, the manufacturers and promotors of kyphoplasty claim some advantage for this procedure over vertebroplasty, in that containment of thick, viscous material within a balloon-created cavity yields less cement leakage than forcing thin, runny, more liquid cement throughout the interstices of a fractured vertebra, as is done in vertebroplasty. Nevertheless, a cement leak does not necessarily mean a complication. Many experienced operators specializing in vertebroplasty have performed hundreds and even thousands of these procedures without ever creating a complication due to cement leakage. The real issue is visualization of the cement and control of its application. The following hypothetical cases represent examples of common pitfalls.
The purpose of this article is to present a series of common complications and pitfalls associated with vertebroplasty and kyphoplasty, with discussions on how to avoid those problems in a practical, case-based essay.
Complication rates for vertebroplasty and kyphoplasty have been reported to range from less than 2% for osteoporotic VCFs to up to 10% for malignant tumor–related VCFs. The complications have included radiculopathy, paralysis, worsening pain, pulmonary emboli, bleeding, infection, and rib fractures. The potential for pneumothorax is always present whenever physicians work in the thoracic region. New VCFs adjacent to those that have already been treated have been implicated, particularly when large amounts of cement have leaked into the adjacent disc spaces. This supposition has been somewhat difficult to validate, however.
Many of the complications of vertebroplasty are directly related to cement leaks. In that regard, the manufacturers and promotors of kyphoplasty claim some advantage for this procedure over vertebroplasty, in that containment of thick, viscous material within a balloon-created cavity yields less cement leakage than forcing thin, runny, more liquid cement throughout the interstices of a fractured vertebra, as is done in vertebroplasty. Nevertheless, a cement leak does not necessarily mean a complication. Many experienced operators specializing in vertebroplasty have performed hundreds and even thousands of these procedures without ever creating a complication due to cement leakage. The real issue is visualization of the cement and control of its application. The following hypothetical cases represent examples of common pitfalls.