What are the possible complications of percutaneous vertebroplasty and kyphoplasty?

Updated: Jul 29, 2020
  • Author: Jeffrey P Kochan, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

The risks of the procedure are low, but they potentially include infection, worsening of pain, and neurologic problems such as weakness or pain in the legs.

Occasionally, the acrylic may extend into the epidural or paraspinous veins. Cement in the epidural venous plexus may lead to an ascending venous thrombosis or contribute to a spinal stenosis or cord or nerve root compression. Acrylic may extend from the paraspinous veins into the vena cava and may result in a pulmonary embolus. The risk of venous embolization increases if the operator cannot adequately identify when the cement begins to pass into the venous system. This risk is reduced by using angiographic equipment with the highest resolution available. The visibility of methylmethacrylate is further improved with the addition of fine metallic powders such as barium mixed with tantalum or tungsten.

Controversy has arisen regarding patients previously treated with vertebroplasty. Patients with osteoporosis should be aware that new fractures can occur in vertebra adjacent to previously treated vertebra. This, however, is not the result of the vertebroplasty procedure; rather, it is a consequence of the wedge deformity of the original fracture exerting additional stresses on the adjacent weakened osteoporotic vertebra (see image below). These patients are at risk of a second fracture of an adjacent vertebral body from this deformity, regardless of whether a vertebroplasty procedure was performed on the first fracture.

Once an anterior wedge compression fracture has oc Once an anterior wedge compression fracture has occurred, the physics of load bearing distribution are altered, creating abnormal stress points on the adjacent vertebra that can lead to a second fracture. This, however, is not the result of the vertebroplasty procedure; rather, it is a consequence of the wedge deformity of the original fracture exerting additional stresses on the adjacent weakened osteoporotic vertebra. A second fracture is likely to occur from this deformity, regardless of whether a vertebroplasty procedure is performed on the first fracture. Some authorities believe vertebroplasty stops the progression of a compression fracture, preventing further wedge deformity and likely reducing the chance of a second fracture.

This author believes that vertebroplasty stops the progression of a compression fracture, preventing further wedge deformity; therefore, vertebroplasty probably reduces the likelihood of a second fracture (see image below), although no studies to date have verified this theory.

Compression fracture after vertebroplasty. Compression fracture after vertebroplasty.

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