Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Object. The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. Methods. Polymethylmethacrylate was injected into 347 vertebral compression fractures in 159 patients. The cement leaked into the epidural space in 92 (26.5%) of 347 treated vertebrae in 64 (40.3%) of the 159 patients, as demonstrated on postoperative computerized tomography scanning. Epidural leakage of PMMA cement occurred more often when injected above the level of T-7 (p = 0.001) than below. The larger the volume of PMMA injected the higher the incidence of epidural leakage (p = 0.03). Using an injector also increased epidural leakage (p = 0.045). The position of the needle tip within the vertebral body and the pattern of venous drainage did not affect epidural leakage of the cement. Leakage of PMMA into the epidural space reduced the pain relief expected after vertebroplasty. The immediate postoperative visual analog scale scores were higher (and therefore reflective of less pain relief) in patients in whom epidural PMMA leakage occurred (p = 0.009). Three months postoperatively, the authors found the highest number of patients presenting with pain relief, including those in the group with epidural leakage, and at this follow-up stage there were no significant differences between the two groups. Conclusions. The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.

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Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty

Medicine ◽

10.1097/md.0000000000006549 ◽

2017 ◽

Vol 96 (14) ◽

pp. e6549 ◽

Cited By ~ 4

Author(s):

Dan Guo ◽

Jun Cai ◽

Shengfei Zhang ◽

Liang Zhang ◽

Xinmin Feng

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

High Viscosity ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures

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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.

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