What are the possible complications of percutaneous vertebroplasty (PVP)?

Updated: Nov 12, 2019
  • Author: Gaurav Gupta, MD; Chief Editor: Justin A Siegal, MD  more...
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Answer

Answer

Complications with percutaneous vertebroplasty are more commonly seen with malignant spinal tumors and hemangiomas than with osteoporotic compression fractures. Chiras et al reported incidents and complications in 274 patients with 10% attributable to spinal tumor cases, 2–5% with vertebral hemangioma cases, and 1–3% seen in osteoporotic compression fractures. [23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43]

It is important to counsel patients on the possibility of the following:

  • Neurologic deficit including paralysis

  • Positioning or needle-placement related fractures including those of the vertebra, rib, or sternum

  • Infection

  • Allergic reaction

  • Pulmonary embolus

  • Hemorrhage
  • Pneumothorax or hemothorax

  • Cement migration

CT scan should be obtained in any patient who experiences new radicular pain post-procedure.  CT scan is particularly useful in patients for which there is a concern for polymethylmethacrylate (PMMA) migration, specifically that into the epidural venous plexus.

CT scan is also useful for assessing patients with severe back pain to assess for a fractured pedicle or transverse process.

New onset regional back pain is suggestive of adjacent level fracture and can be better evaluated with non-contrast MRI. Careful review of the STIR sequence on non-contrasted MRI can help determine the acuity of the fracture.

CT pulmonary angiogram or rib series X-ray can be helpful in patients who develop chest pain in the post-procedure period in addition to a standard EKG. The CT pulmonary angiogram can rule out pulmonary embolus.

Paralysis has been reported but is very uncommon. Precautions should be taken while injecting above L1, with attention to the posterior vertebral body wall; do not allow PMMA to flow into the epidural venous plexus.

Reports are mixed as to whether vertebroplasty predisposes patients to develop additional vertebral fractures. Spine Jack has been shown to have reduced incidence of adjacent level fracture when compared to vertebroplasty or balloon kyphoplasty.


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