Abstract
Complications due to vertebroplasty may be divided into two categories whether or not they are related to polymethylmethacrylate (PMMA) cement leakage from the compressed vertebral body. PMMA leakage is a very frequent occurrence in vertebroplasty is also the main source of complications. Neurological complications are due to cement leakage into the spinal canal and less exceptionally into the intervertebral foramen. The transpedicular needle approach reduces the risk of cement leakage into the foramen. Pulmonary embolism of PMMA may occur when there is a failure to recognize venous migration of cement early during the procedure. Cortical destruction, presence of an epidural soft-tissue mass, highly vascularized lesions, and severe vertebral collapse are factors which increase the rate of complications, which is therefore much higher in metastatic than in osteoporotic vertebral collapse. Prevention of PMMA leakage-related complications is a multifactorial issue including procedure preparation, needle approach and placement, and cement application. The technical refinements which may help reduce the risk of PMMA leakage are reviewed in this article. Experimental data have shown that systemic reactions may occur during vertebroplasty in the absence of cement leakage. These reactions may be partly related to vascular embolism of bone marrow fat. Another controversial issue is a possible increase in the risk of vertebral collapse of adjacent vertebrae following vertebroplasty. Prospective randomized studies are needed to resolve this issue.
Similar content being viewed by others
References
Galibert P, Deramond H, Rosat P, Le Gars D. Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée (Preliminary report on the percutanenous vertebroplasty with acrylic cement as a treatment of vertebral angioma). Neurochirurgie 1987;33:166–168.
Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 1996;199:241–247.
Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996;200:525–530.
Jensen ME, Avery JE, Mathis JM, Kallmes DF, Cloft HJ, Dio JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral compression fractures: technical aspects. AJNR Am J Neuroradiol 1997;18:1897–1904.
Gaughen J, Jensen ME, Schweickert PA, Kaufmann TJ, Marx WF, Kallmes DF. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. AJNR Am J Neuroradiol 2002;23:594–600.
Cortet B, Cotten A, Boutry N, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 1999;26:2222–2228.
Chiras J, Deramond H. Complications des vertébroplasties. In: Chirurgie du rachis. Montpellier, France: Sauramps Medical, 1995:149–153.
Cyteval C, Baron Sarrabère MP, Roux JO, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. AJR Am J Roentgenol 1999;173:1685–1690.
Vasconcelos C, Gailloud Ph, Martin JB, Murphy KJ. Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty (letter). J Vasc Interv Radiol 2001;12:1001–1002.
Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 2002;223:121–126.
Deramond H, Depriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications, and results. Radiol Clin North Am 1998;36:533–546.
Padovani B, Kasriel O, Brunner P, Peretti P. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999;20:375–377.
Scroop R, Eskridge J, Britz GW. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR Am J Neuroradiol 2002;23:868–870.
Aebli N, Krebs J, Dabis G, Walton M, Williams MJA, Theis JC. Fat embolism and acute hypotension during vertebroplasty. Spine 2002;27:460–466.
Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000;25:923–928.
Chiras J, Depriester C, Weill A, Sola Martinez M-T, Deramond H. Vertébroplasties percutanées, Technique et indications. J Neuroradiol 1997;24:45–59.
Cotten A, Boutry N, Cortet B, et al. Percutaneous vertebroplasty: state of the art. Radiographics 1998;18:311–320.
O’Brien JP, Sims JT, Evans AJ. Vertebroplasty in patients with severe vertebral compression fractures: a technical report. AJNR Am J Neuroradiol 2000;21:1555–1558.
Kessler MJ, Kupper JL, Brown RJ. Accidental methyl methacrylate inhalation toxicity in a rhesus monkey (Macaca mulatta). Lab Anim Sci 1977;27:388–390.
Cloft HF, Easton DN, Jensen ME, et al. Exposure of medical personnel to methylmethacrylate vapor during percutaneous vertebroplasty. AJNR Am J Neuroradiol 1999;20:352–353.
McLaughlin RE, Barkalow JA, Allen MS. Pulmonary toxicity of methylmethacrylate vapors: an environmental study. Arch Environ Health 1979;34:336–338.
Wheater RIL. Hazard of methyl methacrylate to operating room personnel. JAMA 1976;235:3652.
Marez T, Edmé JL, Boulenguez C, Shirali P, Hauguenoer JM. Bronchial symptoms and respiratory functions in workers exposed to methylmethacrylate. Br J Ind Med 1993;50:894–897.
Wong HY, Vidovich MI. Acute bronchospasm associated with polymethylmethacrylate cement. Anesthesiology 1997;87:696–698.
Kirby BS, Doyle A, Gilula LA. Acute bronchospasm due to exposure to polymethylmethacrylate vapors during percutaneous vertebroplasty. AJR Am J Roentgenol 2003;180:543–544.
Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003;226:119–126.
Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000;39:1410–1414.
Lindsay R, Silverman S, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001;285:320–323.
Wasnich U. Vertebral fracture epidemiology. Bone 1996;18:179S–183S.
Philipps H, Cole PV, Lettin AW. Cardiovascular effects of implanted bone cement. BMJ 1971;3:460–461.
Peebles DJ, Ellis RH, Stride SDK, Simpson BRJ. Cardiovascular effects of methylmethacrylate cement. BMJ 1972;1:349–351.
Ereth MH, Weber JG, Abel MD, et al. Cemented versus noncemented total hip arthroplasty: embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc 1992;67:1066–1074.
Bai B, Jazrawi LM, Kummer FJ, et al. The use of an injectable, biodegradable calcium phosphate bone substitute for the prophylactic augmentation of osteoporotic vertebrae and the management of vertebral compression fractures. Spine 1999;24:1521–1526.
Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol 1994;15:83–86.
Rudigier JF, Ritter G. Pathogenesis of circulatory reactions triggered by nervous reflexes during the implantation of bone cements. Res Exp Med (Berl) 1983;183:77–94.
Ahmed M, Bjurholm A, Kreicbergs A, et al. Neuropeptide Y, tyrosine hydroxylase, and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine. Spine 1993;18:268–273.
Antonacci MD, Mody DR, Heggeness MH. Innervation of the human vertebral body: a histologic study. J Spinal Disord 1998;11:526–531.
Breed AL. Experimental production of vascular hypotension, and bone marrow and fat embolism with methylmethacrylate cement: traumatic hypertension of bone. Clin Orthop 1974;0:227–244.
Kaufmann TJ, Jensen ME, Ford G, Gill LL, Marx WF, Kallmes DF. Cardiovascular effects of polymethylmethacrylate use in percutaneous vertebroplasty. AJNR Am J Neuroradiol 2002;23:601–604.
Sarzier JS, Evans AJ. Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty. AJNR Am J Neuroradiol 2003;24:1001–1012.
Wong W, Mathis J. Is intraosseous venography a significant safety measure in performance of vertebroplasty. J Vasc Interv Radiol 2002;13:137–138.
Peh WCG, Gilula LA. Additional value of a modified method of intraosseous venography during percutaneous vertebroplasty. AJR Am J Roentgenol 2003;180:87–91.
Belkoff SM, Mathis JM, Erbe EM, et al. Biomechanical evaluation of a new bone cement for use in vertebroplasty (see comments). Spine 2000;25:1061–1064.
McGraw JK, Heatwole EV, Strnad BT, Silber JS, Patzilk SB, Boorstein JM. Predictive value of intraosseous venography before percutaneous vertebroplasty. J Vasc Interv Radiol 2002;13:149–153.
Do HM. Intraosseous venography during percutaneous vertebroplasty: is it needed? AJNR Am J Neuroradiol 2002;23:508–509.
Lieberman IH, Dudeney S, Reinhardt M-K, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 2001;26:1631–1638.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Laredo, J.D., Hamze, B. Complications of percutaneous vertebroplasty and their prevention. Skeletal Radiol 33, 493–505 (2004). https://doi.org/10.1007/s00256-004-0776-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-004-0776-8