Complications of percutaneous vertebroplasty and their prevention

Complications due to vertebroplasty may be divided into two categories whether or not they are related to polymethylmethacrylate (PMMA) cement leakage from the compressed vertebral body. PMMA leakage is a very frequent occurrence in vertebroplasty is also the main source of complications. Neurological complications are due to cement leakage into the spinal canal and less exceptionally into the intervertebral foramen. The transpedicular needle approach reduces the risk of cement leakage into the foramen. Pulmonary embolism of PMMA may occur when there is a failure to recognize venous migration of cement early during the procedure. Cortical destruction, presence of an epidural soft-tissue mass, highly vascularized lesions, and severe vertebral collapse are factors which increase the rate of complications, which is therefore much higher in metastatic than in osteoporotic vertebral collapse. Prevention of PMMA leakage-related complications is a multifactorial issue including procedure preparation, needle approach and placement, and cement application. The technical refinements which may help reduce the risk of PMMA leakage are reviewed in this article. Experimental data have shown that systemic reactions may occur during vertebroplasty in the absence of cement leakage. These reactions may be partly related to vascular embolism of bone marrow fat. Another controversial issue is a possible increase in the risk of vertebral collapse of adjacent vertebrae following vertebroplasty. Prospective randomized studies are needed to resolve this issue.

[1]  J. Theis,et al.  Fat Embolism and Acute Hypotension During Vertebroplasty , 2002 .

[2]  K. Murphy,et al.  Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty. , 2001, Journal of vascular and interventional radiology : JVIR.

[3]  L. Gilula,et al.  Additional value of a modified method of intraosseous venography during percutaneous vertebroplasty. , 2003, AJR. American journal of roentgenology.

[4]  A. Lettin,et al.  Cardiovascular Effects of Implanted Acrylic Bone Cement , 1971, British medical journal.

[5]  J. Rudigier,et al.  Pathogenesis of circulatory reactions triggered by nervous reflexes during the implantation of bone cements , 1983, Research in experimental medicine. Zeitschrift fur die gesamte experimentelle Medizin einschliesslich experimenteller Chirurgie.

[6]  R. Assaker,et al.  Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. , 1996, Radiology.

[7]  R. J. Brown,et al.  Accidental methyl methacrylate inhalation toxicity in a rhesus monkey (Macaca mulatta). , 1977, Laboratory animal science.

[8]  M. Abel,et al.  Cemented versus noncemented total hip arthroplasty--embolism, hemodynamics, and intrapulmonary shunting. , 1992, Mayo Clinic proceedings.

[9]  H. Deramond,et al.  [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. , 1987, Neuro-Chirurgie.

[10]  B Padovani,et al.  Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. , 1999, AJNR. American journal of neuroradiology.

[11]  P. Taourel,et al.  Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. , 1999, AJR. American journal of roentgenology.

[12]  J. Mcgraw,et al.  Predictive value of intraosseous venography before percutaneous vertebroplasty. , 2002, Journal of vascular and interventional radiology : JVIR.

[13]  L. Gilula,et al.  Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. , 2002, Radiology.

[14]  A. Evans,et al.  Vertebroplasty in patients with severe vertebral compression fractures: a technical report. , 2000, AJNR. American journal of neuroradiology.

[15]  R. Scroop,et al.  Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. , 2002, AJNR. American journal of neuroradiology.

[16]  J. Barr,et al.  Percutaneous Vertebroplasty for Pain Relief and Spinal Stabilization , 2000, Spine.

[17]  B. Bai,et al.  The use of an injectable, biodegradable calcium phosphate bone substitute for the prophylactic augmentation of osteoporotic vertebrae and the management of vertebral compression fractures. , 1999, Spine.

[18]  P. Shirali,et al.  Bronchial symptoms and respiratory function in workers exposed to methylmethacrylate. , 1993, British journal of industrial medicine.

[19]  D F Kallmes,et al.  Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. , 1997, AJNR. American journal of neuroradiology.

[20]  M. Vidovich,et al.  Acute bronchospasm associated with polymethylmethacrylate cement. , 1997, Anesthesiology.

[21]  H. Deramond,et al.  Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. , 1998, Radiologic clinics of North America.

[22]  I. Lieberman,et al.  Initial Outcome and Efficacy of “Kyphoplasty” in the Treatment of Painful Osteoporotic Vertebral Compression Fractures , 2001, Spine.

[23]  J. Chiras,et al.  [Percutaneous vertebral surgery. Technics and indications]. , 1997, Journal of neuroradiology. Journal de neuroradiologie.

[24]  H. Do.  Intraosseous venography during percutaneous vertebroplasty: is it needed? , 2002, AJNR. American journal of neuroradiology.

[25]  R. McLaughlin,et al.  Pulmonary toxicity of methyl methacrylate vapors: an environmental study. , 1979, Archives of environmental health.

[26]  L. Gilula,et al.  Acute bronchospasm due to exposure to polymethylmethacrylate vapors during percutaneous vertebroplasty. , 2003, AJR. American journal of roentgenology.

[27]  X Demondion,et al.  Percutaneous vertebroplasty: state of the art. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[28]  R. Wasnich.  Vertebral fracture epidemiology. , 1996, Bone.

[29]  A. Gangi,et al.  Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. , 1994, AJNR. American journal of neuroradiology.

[30]  D. Kallmes,et al.  Exposure of medical personnel to methylmethacrylate vapor during percutaneous vertebroplasty. , 1999, AJNR. American journal of neuroradiology.

[31]  A. Breed.  Experimental production of vascular hypotension, and bone marrow and fat embolism with methylmethacrylate cement. Traumatic hypertension of bone. , 1974, Clinical orthopaedics and related research.

[32]  A. Evans,et al.  Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty. , 2003, AJNR. American journal of neuroradiology.

[33]  M. Heggeness,et al.  Innervation of the human vertebral body: a histologic study. , 1998, Journal of spinal disorders.

[34]  B. Simpson,et al.  Cardiovascular Effects of Methylmethacrylate Cement , 1972, British medical journal.

[35]  F. Grados,et al.  Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. , 2009, Rheumatology.

[36]  M. Schultzberg,et al.  Neuropeptide Y, Tyrosine Hydroxylase and Vasoactive Intestinal Polypeptide‐Immunoreactive Nerve Fibers in the Vertebral Bodies, Discs, Dura Mater, and Spinal Ligaments of the Rat Lumbar Spine , 1993, Spine.

[37]  S. Belkoff,et al.  Biomechanical evaluation of a new bone cement for use in vertebroplasty. , 2000, Spine.

[38]  B Delcambre,et al.  Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. , 1999, The Journal of rheumatology.

[39]  Joshua A Hirsch,et al.  Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. , 2003, Radiology.

[40]  D. Kallmes,et al.  Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. , 2002, AJNR. American journal of neuroradiology.

[41]  W. Wong,et al.  Is intraosseous venography a significant safety measure in performance of vertebroplasty? , 2002, Journal of vascular and interventional radiology : JVIR.

[42]  P Geusens,et al.  Risk of new vertebral fracture in the year following a fracture. , 2001, JAMA.

[43]  J. Theis,et al.  Fat Embolism and Acute Hypotension During Vertebroplasty: An Experimental Study in Sheep , 2002, Spine.

[44]  J. Chiras,et al.  Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. , 1996, Radiology.

[45]  D. Kallmes,et al.  Cardiovascular effects of polymethylmethacrylate use in percutaneous vertebroplasty. , 2002, AJNR. American journal of neuroradiology.