Epidemiology and detection of cement leakage in patients with spine metastases treated with percutaneous vertebroplasty: A 10-year observational study

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

Download Full-text

Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

Case Reports in Orthopedics ◽

10.1155/2015/870810 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Guido Zarattini ◽

Adam Farrier ◽

Federico Sibona

Keyword(s):

Percutaneous Vertebroplasty ◽

Rare Complication ◽

Cement Leakage ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Leg Pain ◽

Compression Fractures ◽

First Case ◽

Seizure Syndrome ◽

Osteoporotic Compression Fractures

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty.Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures.Study Design. Case report.Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis.Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management.Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality.

Download Full-text

Comparison of Cement Leakage Rate and Severity After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures Using Front-Opening Versus Side-Opening Cannulas

Orthopedics ◽

10.3928/01477447-20210416-03 ◽

2021 ◽

Vol 44 (3) ◽

pp. 134-140

Author(s):

Zixian Wu ◽

Linqiang Y ◽

Ling Mo ◽

Xiaobing Jiang ◽

Jianchao Cui ◽

...

Keyword(s):

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Leakage Rate ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures

Download Full-text

Percutaneous Vertebroplasty Combined with Percutaneous Pediculoplasty for Lytic Vertebral Body and Pedicle Lesions of Metastatic Tumors

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e347 ◽

2015 ◽

Vol 3;18 (3;5) ◽

pp. E347-E353

Author(s):

Zhong-Liang Deng

Keyword(s):

Observational Study ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Management Practice ◽

Medical Center ◽

Therapeutic Option ◽

Retrospective Observational Study ◽

Symptom Duration ◽

Single Center ◽

Metastatic Tumors

Background: Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique derived from vertebroplasty. Objectives: To evaluate the short-term analgesic effect of percutaneous vertebroplasty (PV) and percutaneous pediculoplasty (PP) in patients with lytic vertebral body and pedicle lesions of metastatic tumors. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: Single-center retrospective observational study of all patients managed with PV and PP for painful vertebral body and pedicle metastatic tumors between 2007 and 2013. For each patient, symptom duration and pain intensity were recorded. PP was performed under local analgesia, in the prone position, with C-arm fluoroscopy guidance. The mixture of PMMA and Doxorubicin was delivered into the vertebral body with a non-beveled needle for the initial treatment followed by the mixture delivery into the lytic pedicle during needle withdrawal. Results: Nine patients (5 women, 4 men) were enrolled in the study with a mean age of 65.9 years (range 57 – 75). Technical success was defined as the ability to access the lesion using the approach. A positive clinical response for pain relief was achieved in these patients in whom vertebroplasty and pediculoplasty had been performed. Pain level was not significantly reduced in 3 patients in whom just vertebroplasty has been performed because the medial wall of the pedicle was destroyed by the metastatic lesion. Limitations: This study is limited by its sample size. Conclusions: PV and PP via the transpedicular approach for infiltrated vertebral bodies and infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option. Key words: Percutaneous pediculoplasty, percutaneous vertebroplasty, lytic pedicular lesions, bone cement

Download Full-text

A Rare Presentation of Subacute Progressive Ascending Myelopathy Secondary to Cement Leakage in Percutaneous Vertebroplasty

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000000028 ◽

2014 ◽

Vol 93 (5) ◽

pp. 431-436 ◽

Cited By ~ 3

Author(s):

Rohit Prakash Bhide ◽

Apurba Barman ◽

Shiela Mary Varghese ◽

Ahana Chatterjee ◽

Suraj Mammen ◽

...

Keyword(s):

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Rare Presentation

Download Full-text

Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

10.21203/rs.2.22351/v1 ◽

2020 ◽

Author(s):

Feng Miao ◽

Xiaojun Zeng ◽

Wei Wang ◽

Zhou Zhao

Keyword(s):

Percutaneous Vertebroplasty ◽

Body Height ◽

Cement Leakage ◽

High Viscosity ◽

Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Low Viscosity ◽

Pain Scores ◽

Group A ◽

Group B

Abstract Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

Download Full-text

A case of multilevel percutaneous vertebroplasty for vertebral metastases resulting in temporary paraparesis

Journal of International Medical Research ◽

10.1177/0300060519835084 ◽

2019 ◽

Vol 48 (2) ◽

pp. 030006051983508

Author(s):

Guan Shi ◽

Fei Feng ◽

Chen Hao ◽

Jia Pu ◽

Bao Li ◽

...

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Spinal Nerve ◽

Vertebral Compression Fractures ◽

Vertebral Metastases ◽

Osteoporotic Vertebral Compression Fractures ◽

Invasive Treatment ◽

Compression Fractures ◽

Cord Injury

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. We report the rare case of a patient who underwent multilevel PVP for vertebral metastases, with no bone cement leakage or spinal cord injury, but who developed temporary paraparesis.

Download Full-text