Infection following percutaneous vertebral augmentation with polymethylmethacrylate
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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.
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.
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.
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.
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.
KeywordsSpinal infection Vertebroplasty Kyphoplasty Spondylitis Spondylodiscitis Compression fracture
Compliance with ethical standards
Conflicts of interest
- 2.Unit N, Chandra RV (2013) Vertebral augmentation: update on safety, efficacy, cost effectiveness and increased survival? Pain physician 16:309–320Google Scholar
- 4.Gallbert P, Deramond H, Rosat P (1987) Preliminary note on the treatment of vertebral angioma by pereutaneous acrylic vertebmplasty. Neurochirurgie 33:166–168Google Scholar
- 8.Papanastassiou ID, Phillips FM, Van Meirhaeghe J, Berenson JR, Andersson GB, Chung G, Small BJ, Aghayev K, Vrionis FD (2012) Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J 21:1826–1843CrossRefGoogle Scholar
- 23.Shin J-H, Ha K-Y, Kim K-W, Lee J-S, Joo M-W (2008) Surgical treatment for delayed pyogenic spondylitis after percutaneous vertebroplasty and kyphoplastyGoogle Scholar
- 29.Santbergen B, Vriens P, De Lange W, Van Kasteren M (2013) Combined infection of vertebroplasty and aortic graft after intravesical BCG treatment. BMJ Case Reports 2013:bcr2012008161Google Scholar
- 39.Chen Y-J, Chen H-Y, Hsu H-C (2014) Re: Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J 13:1809–1817 The spine journal: official journal of the North American Spine Society 14:1366Google Scholar