Cement Leakage and the Need for Prophylactic Fenestration of the Spinal Canal During Vertebroplasty

2002 ◽  
Vol 84 (4) ◽  
pp. 689-690
Author(s):  
Kevin D. Harrington
Keyword(s):  
Spinal Canal ◽  
Cement Leakage

Microsurgical interlaminary vertebro- and kyphoplasty for severe osteoporotic fractures

2004 ◽  
Vol 100 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Bronek M. Boszczyk ◽  
Michael Bierschneider ◽  
Katharina Schmid ◽  
Andreas Grillhösl ◽  
Björn Robert ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Osteoporotic Fractures ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Decompressive Surgery ◽  
Content Type ◽  
Osteoporotic Vertebral Fractures ◽  
Four Levels ◽  
Fine Print

Object. Percutaneous vertebro- and kyphoplasty have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures. In the setting of severe fractures involving fragmentation of the posterior wall and neural compromise, however, decompressive surgery cannot be performed and epidural cement leakage is poorly controlled. A microsurgical interlaminary approach for vertebro- and kyphoplasty was developed to allow spinal decompression and control of the spinal canal during augmentation. Methods. Interlaminary vertebro- or kyphoplasty was performed in 24 patients with osteoporotic fractures involving neural compression or posterior wall fragmentation. After unilateral microsurgical fenestration, decompression of the spine, and gentle mobilization of the thecal sac, vertebro- or kyphoplasty was performed directly through the posterior wall of the fractured vertebral body. Cement was injected under microscopic and fluoroscopic control, with the option of immediate exploration of the exposed spinal canal. Thirty-four levels (T-8 to L-5) were treated. Mean blood loss was less than 100 ml and augmentation added 10 to 40 minutes to the entire procedure. Cement leakage associated with the kyphoplasty procedure was less than that in vertebroplasty. There were no major complications. One patient was lost to follow up. Clinical outcome was good or excellent in 17 of the 23 patients available for follow-up (1 to 31—month) evaluation. Conclusions. The present microsurgical interlaminary approach for vertebro- and kyphoplasty enables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decompressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively. This technique can be regarded as a procedure on the treatment continuum between percutaneous augmentation and conventional open reconstruction.

scholarly journals Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E1021-E1028
Author(s):  
Yan Yang
Keyword(s):  
Spinal Canal ◽  
Invasive Procedure ◽  
Cement Leakage ◽  
Spinal Canal Stenosis ◽  
Stage Iii ◽  
Canal Stenosis ◽  
Institutional Review ◽  
Kummell’S Disease ◽  
Kümmell’S Disease

Background: Percutaneous kyphoplasty (PKP) has been proven as an effective, minimally invasive procedure for the treatment of Kummell’s disease in the early stages. However, a risk of cement leakage and further neurological damage remains during and after PKP, especially in chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Objective: To evaluate the feasibility and efficacy of PKP for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Study Design: A retrospective evaluation of postoperative radiographs. Setting: Pain management clinic. Methods: A retrospective study was performed on 9 patients with 11 levels managed with PKP for chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Clinical and radiological outcomes were assessed. Results: Substantial pain relief was attained in all the patients. Both visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from pre- to post-operation (P < 0.05), and remained unchanged at every follow-up. No neurological deterioration was found. Postoperatively, the anterior and midline vertebral body heights were significantly corrected (P < 0.05), and were sustained at the final follow-up. Similar results were seen in the correction of kyphotic angle. Neither cement leakage into the spinal canal nor further dislodging of the posterior vertebral fragments occurred. Two cases experienced subsequent fractures with one having a second PKP and the other being treated conservatively. Limitations: Retrospective study of 9 cases with 11 levels due partly to the rarity of the disorder. Conclusions: PKP is an effective, minimally invasive procedure for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal stenosis, leading to a significant relief of symptoms and improvement of functional status. Institutional Review: This study was approved by the Institutional Review Board. Key words: Kummell’s disease, kyphoplasty, spine, osteoporosis, cement leakage, polymethylmethacrylate, neurological deficits, burst fractures

scholarly journals Dorsolumbar Vertebroplasty- A Retrospective Study

2021 ◽  
Author(s):  
Murat Yilmaz ◽  
Nihat Acar ◽  
Ahmet Aybar ◽  
Ahmet Karakasli
Keyword(s):  
Retrospective Study ◽  
Spinal Canal ◽  
Posterior Longitudinal Ligament ◽  
Cement Leakage ◽  
Radicular Pain ◽  
Decompression Surgery ◽  
Inclusion Criteria ◽  
Vertebral Metastasis ◽  
Disc Space ◽  
The Mean

Introduction: Percutaneous Vertebroplasty (PVP) is a procedure frequently performed to obtain pain relief and mechanical strengthening of the collapsed vertebral body which may be caused by variant reasons. Aim: To assess frequent complications commonly encountered during vertebroplasty procedure. Materials and Methods: A retrospective study was conducted on 1375 patients followed from January 2005 and June 2012 in Department of Neurosurgery, faculty of medicine, Dokuz Eylül University. Severe vertebral fracture collapse (vertebra plana), vertebral metastasis, quadriplegic patients and bed-ridden patients were excluded from this study, whereas active mobile patients without associated severe co-morbidities were included in the study. Pain, pattern of cement leakage and associated complications had been assessed. Results: Total 601 patients who fullfilled the inclusion criteria {244 (40.5%) males, 357 (59.5%) females}, average age was 63.04±7.4 (range 34 to 90) years, had undergone the PVP procedure. Mean preoperative Visual Analog Scale (VAS) was 8.51±1.5, whereas after one and six months, the mean postoperative VAS were 1.94±1.0 and 2.53±2.2, respectively. Central spinal canal leakage has been observed in four cases. Three patients had developed transient monoparesis and radiculopathy symptoms. Whereas, the fourth patient developed paraplegia. Cement leakage had been tolerated well by one patient, where symptomatic resolution occurred within one month. However, decompressive foraminotomy had been performed for two patients on the 24th and 38thdays postoperatively due to intractable radicular pain. Immediate total laminectomy and decompression surgery had been performed for removal of the cement leakage to the spinal canal for the patient who developed total paraplegia. Asymptomatic leakage had been recognised beneath the posterior longitudinal ligament in 42 patients (6.9%), beneath the anterior longitudinal ligament in 18 patients (2.9%) and into disc space in 31 patients (5.1%). Venous leakage occurred in four patients (0.6%) and was asymptomatic in all of them. Conclusion: Vertebroplasty should be performed in a fully equipped operation theater in order to be able to revert quickly to open surgery in case of cement leakage into the spinal canal.

scholarly journals Vesselplasty versus vertebroplasty in the treatment of osteoporotic vertebral compression fractures with posterior wall rupture

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110663
Author(s):  
Kai Xu ◽  
Ya-Ling Li ◽  
Song-Hua Xiao
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Spinal Canal ◽  
Operation Time ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Leakage Rate ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Osteoporotic Compression Fractures

Objective This study was performed to compare the effectiveness and safety of vesselplasty versus vertebroplasty in the treatment of osteoporotic compression fractures with posterior wall rupture. Methods Patients who underwent treatment of a single osteoporotic vertebral compression fracture with posterior wall rupture from January 2016 to February 2020 were retrospectively reviewed. They were divided into a vesselplasty group (n = 17) and a vertebroplasty group (n = 43). Pain relief, radiographic outcomes, and bone cement leakage were compared between the two groups. Results There were no significant differences in the operation time, postoperative pain relief, vertebral compression recovery, or local Cobb angle improvement between the two groups. However, the overall bone cement leakage rate (29.4% vs. 67.4%) and spinal canal leakage rate (0.0% vs. 30.2%) were significantly lower in the vesselplasty group than vertebroplasty group. Conclusions Vesselplasty offers similar pain relief and vertebral compression recovery but lower spinal canal leakage compared with vertebroplasty. Vesselplasty is thus a better option than vertebroplasty for patients with osteoporotic compression fractures with posterior wall rupture.

scholarly journals A mysterious risk factor for bone cement leakage into the spinal canal through the Batson vein during percutaneous kyphoplasty: a case control study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuai Zhang ◽  
Gao Ju Wang ◽  
Qing Wang ◽  
Jin Yang ◽  
Shuang Xu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Three Dimensional ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Thoracic Vertebrae ◽  
Percutaneous Kyphoplasty ◽  
Thoracic Spinal

Abstract Background Percutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP. Methods Ninety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP. Results The PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm2, and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm2, and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05). Conclusions The PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.

scholarly journals A Nomogram to Predict Intra-Spinal Canal Cement Leakage Among Elderly Patients with Spine Metastases: An Internal-Validated Model

2021 ◽  
Vol Volume 16 ◽  
pp. 1735-1746
Author(s):  
Xuedong Shi ◽  
Yunpeng Cui ◽  
Yuanxing Pan ◽  
Bing Wang ◽  
Mingxing Lei
Keyword(s):  
Elderly Patients ◽  
Spinal Canal ◽  
Cement Leakage ◽  
Spine Metastases

scholarly journals Cement Leakage into the Posterior Spinal Canal during Balloon Kyphoplasty: A Case Report

2007 ◽  
Vol 15 (2) ◽  
pp. 222-225 ◽  
Author(s):  
S Becker ◽  
J Meissner ◽  
A Tuschel ◽  
A Chavanne ◽  
M Ogon
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Spinal Canal ◽  
Invasive Procedure ◽  
Balloon Kyphoplasty ◽  
Cement Leakage ◽  
Neurological Complications ◽  
Minimally Invasive Procedure ◽  
Pedicle Perforation

We report a case of cement leakage into the posterior spinal canal due to inadvertent pedicle perforation during balloon kyphoplasty. The leakage was corrected immediately without any sequelae. Features seen on radiography and the minimally invasive procedure used for removal are described. The postoperative radiographs of 100 consecutive patients treated with balloon kyphoplasty were subsequently reviewed. Only one patient had a similar leakage but had no neurological complications.

scholarly journals A Lateral Opening Injection Tool Used In Percutaneous Vertebroplasty To Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study In 66 Cases

2021 ◽  
Author(s):  
Xin Sun ◽  
Jia Wang ◽  
Xingzhen Liu ◽  
Hairong Tao ◽  
Tong Zhu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Spinal Canal ◽  
Percutaneous Vertebroplasty ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Height Loss ◽  
Vertebral Height ◽  
Burst Fractures ◽  
Posterior Wall Fracture

Abstract Background: This study aimed to assess the results of percutaneous vertebroplasty (PVP) with a lateral opening injection tool for treating asymptomatic osteoporotic vertebral burst fractures (OVBFs) patients.Methods: 66 patients diagnosed with acute asymptomatic OVBFs with a spinal canal occupational ratio under 20% were treated with bilateral PVP using a lateral opening injection tool in our study. The related clinical outcomes and images were assessed, including Visual Analogue Scale (VAS), vertebral height (VH) ratio (=fractured VH/ adjacent nonfractured VH), the bone union of the fractured vertebral posterior wall, bone cement distribution, and complications.Results: The VAS scores were 3.80±0.40 at postoperative one day and 0.59±0.41 at last follow-up, significantly lower than 8.37±0.49 at pre-operation (P<0.05). The vertical distribution of bone cement in 60 cases contacted the upper and lower endplates of fractured vertebras. There was no leakage of bone cement in the spinal canal or displacement of posterior wall fracture to the spinal canal in all cases. There was asymptomatic cement leakage in 7 cases. The mean anterior, middle and posterior vertebral height ratios were significantly increased after PVP compared with preoperative values in all patients (P<0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Three months postoperatively, the posterior wall of fractured vertebral bodies was healed in all cases according to CT images. Conclusions: PVP using a lateral opening injection tool was effective and safe for treating asymptomatic OVBF patients.

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