1150 Kyphoplasties Over 7 Years: Indications, Techniques, and Intraoperative Complications

Abstract

In our cohort of 555 patients with a total of 1150 vertebral fractures treated with kyphoplasty we performed a 30-day postoperative analysis of cement leakage, neurological symptoms, pulmonary embolism, and infections. In our department, 22% of kyphoplasties were performed with calcium phosphate cement and the remainder with polymethylmethacrylate. All patients were initially assessed by an interdisciplinary kyphoplasty colloquium, composed of consultants in traumatology, radiology, and endocrinology. Indications included fresh traumatic vertebral fractures; painful sintered osteoporotic vertebrae; osteolysis and painful vertebral body collapse caused by multiple myelomas; and lymphomas and pathological fractures due to metastases of malignant tumors (prostate cancer, breast cancer, ovarian cancer, and malignant melanoma) or benign vertebral tumors (hemangioma). Contraindications included patients with instability of the posterior wall and/or pedicles, an infection of the fractured vertebra, a severe hemorrhagic diathesis, known allergies to the cements, pregnancy, and ASA score of 4. The standard postoperative computed tomography scan of the kyphoplasty-treated vertebrae revealed a dorsal cement leakage in 38 vertebrae representing 3.3% of all levels. A permanent monoparesis of the left leg, 2 cases of temporary neurological deficits, 2 cases of hemorrhage, and 1 asymptomatic pulmonary embolism were observed as postoperative complications. We observed no complications relating to polymethylmethacrylate described in the literature. By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a safe and effective procedure for the treatment of various vertebral fractures.

Chemical and physical properties of bone cement for vertebroplasty

“…Vertebroplasty has been widely accepted as a therapeutic strategy for painful osteoporotic compression fractures. [3][4][5][6] In this procedure, bone cement is percutaneously injected under pressure into a vertebra through a cannula [ Figure 1]. Polymerization of the bone cement stabilizes the fractured vertebra by increasing its mechanical strength, thereby provid-ing symptomatic pain relief.…”

“…Polymerization of the bone cement stabilizes the fractured vertebra by increasing its mechanical strength, thereby provid-ing symptomatic pain relief. [3,7,8] Vertebroplasty is a very good surgical choice, as this surgical procedure eliminates the risk of major spinal surgery, and through rapid pain relief, may provide early ambulation and rehabilitation for elderly patients. [9,10] A report on vertebroplasty was first published in 1987 for the management of a painful, aggressive hemangioma of a vertebral body.…”

Bone healing response to a synthetic calcium sulfate/β‐tricalcium phosphate graft material in a sheep vertebral body defect model

“…Therefore, any alternative to PMMA in this demanding indication must demonstrate adequate strength and stability to prevent further vertebral collapse. Some success with calcium phosphate cements (CPCs) has been reported, 17,18 but observations regarding subsequent postoperative collapse, 19,20 indicate it's use is not recommended for vertebral augmentation as a result of the materials low resistance to flexural, tractive, and shear forces in comparison to PMMA. 21 Indeed biomechanical evaluation of CPCs under a cyclic loading regime found evidence of fatigue.…”

Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology

“…Although the incidence of infectious complications with vertebral body augmentation is less than 0.5% (182,183), the difficulty of treating cement contamination (ie, surgical debridement) argues for the use of prophylaxis (138). Antibiotic agents targeting skin flora are generally recommended (184).…”