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Infection following percutaneous vertebral augmentation with polymethylmethacrylate

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Abstract

Summary

Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexistent spondylitis can cause life-threatening complications in frail patients with notable comorbidities. In such cases, urgent culture and biopsy and the long-term use of proper antibiotics are necessary.

Purpose

Infection following vertebral augmentation with polymethylmethacrylate (PMMA) is rare. We aimed to analyze 11 cases of pyogenic spondylitis and spondylodiscitis that occurred after vertebroplasty or kyphoplasty and to review similar cases in the literature.

Methods

All cases of postoperative spinal infections in our institution between January 2005 and November 2016 that primarily underwent percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. Eleven patients (mean age 76.3 years) were included.

Results

The incidence of infection following vertebroplasty/kyphoplasty was 0.36%. Postoperative infection occurred in 3 of 826 cases. All patients underwent combined surgical and antibiotic treatment because of neurologic deficit on the initial diagnosis of the infection or failure of prior medical treatment of the infection. The surgical procedure was thorough debridement of infected tissue and material including PMMA following anterior column reconstruction via anterior/posterior/combined approach in 10 patients and percutaneous pedicle screw fixation alone in 1 patient aged 96 years. The mean follow-up period was 21.1 months after the revision operation, excluding one patient who died 17 days after revision surgery. Ten patients recovered from infection.

Conclusions

Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexisting spondylitis can develop into a life-threatening complication in frail patients with notable comorbidities. In treating infected vertebroplasty and kyphoplasty, immediate culture and biopsy and the long-term use of proper antibiotics are critical. Prompt surgical treatment should be considered in case of significant neurologic deficit, severe instability due to infected fracture, and resistance to antibiotics.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jae-Woo Park

  2. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, South Korea

    Sang-Min Park

  3. Department of Orthopedic Surgery, Seokjeong Wellpark Hospital, Gochang, South Korea

    Hui Jong Lee

  4. Department of Orthopedic Surgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    Choon-Ki Lee, Bong-Soon Chang & Hyoungmin Kim

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  1. Jae-Woo Park
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Correspondence to Hyoungmin Kim.

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Park, JW., Park, SM., Lee, H.J. et al. Infection following percutaneous vertebral augmentation with polymethylmethacrylate. Arch Osteoporos 13, 47 (2018). https://doi.org/10.1007/s11657-018-0468-y

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