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Revision strategies for complications and failure of vertebroplasties

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Abstract

Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk- or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, ROC

    Shih-Chieh Yang, Shang-Won Yu, Yuan-Kun Tu & Yu-Hsien Kao

  2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC

    Shih-Chieh Yang & Wen-Jer Chen

  3. Institute of Biomedical Engineering, National Cheng-Kung University, 1 University Road, Tainan, 70101, Taiwan, ROC

    Shih-Chieh Yang & Kao-Chi Chung

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  1. Shih-Chieh Yang
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  2. Wen-Jer Chen
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Correspondence to Kao-Chi Chung.

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No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Yang, SC., Chen, WJ., Yu, SW. et al. Revision strategies for complications and failure of vertebroplasties. Eur Spine J 17, 982–988 (2008). https://doi.org/10.1007/s00586-008-0680-3

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  • DOI: https://doi.org/10.1007/s00586-008-0680-3

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