Cement leakage as a possible complication of balloon kyphoplasty—is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?

Walter, Jan; Hacıyakupoğlu, Ersin; Waschke, Albrecht; Kalff, Rolf; Ewald, Christian

doi:10.1007/s00701-011-1239-3

Cited by 45 publications

(35 citation statements)

References 28 publications

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“…This was a little different with previous study that broken posterior wall related with higher rate of CL into the spinal canal. [5] It was because the maneuver to reduce fracture by inflating the balloon might further damage the fragile broken upper endplate, especially through transpedicle approach. Also CL through endplate cortical disruption may be very quick that it can be hard to stop.…”

Section: Discussionmentioning

confidence: 99%

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Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery

Li¹,

Li²,

Qing-jun³

et al. 2017

Medicine

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The purpose of this study was to investigate cement leakage (CL) in osteoporotic vertebral compression fractures (OVCFs) with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty (PKP) surgery.This study included a series of 77 patients (23 males, 54 females) with single level osteoporotic vertebral body fracture (OVCF) who underwent unilateral PKP in our hospital. Preoperative x-ray, computed tomography (CT) scan, and 3-dimensional reconstructions were studied. During the PKP procedure, needle was carefully put to avoid too near to the cortical defect according to CT image. High-viscosity bone cement was used via unilateral PKP. Radiographic outcomes were evaluated by assessment of vertebral body wall breakage, fracture type, and vertebral body change. The exact rate of CL was analyzed.A total of 77 patients with single-level OVCF were included in this study. The mean age of the patients was 74.8 ± 8.0 years. Among these cases, 7 (9.1%) involved the thoracic spine (T3–T10), 60 (77.9%) involved the thoracolumbar spine (T10–L2), and 10 (13.0%) involved the lumbar spine (L3–L5). There were 27 vertebral bodies found posterior wall breakage, 51 vertebral bodies found endplate breakage, and 49 vertebral bodies found anterior-lateral wall breakage. CT scan was more efficient in detecting vertebral body wall breakage and CL than x-ray (P < .001). No neurological symptoms were found after surgery. Both cases with CL (CL group) and cases without cement leakage (NCL group) experienced vertebral height restoration (HR) with similar cement volume CV. There were no significant difference between the two groups about the parameter HR and CV. Severe vertebral body fracture and biconcave fracture had more CL than other groups. OVCF cases with cortical defect had more CL rate than those without cortical defect; however, no significant difference was found in the correlation between vertebral wall breakage and CL.Cortical defect remains a potential risk of CL during PKP surgery. Careful preoperative evaluation and using high-viscosity bone cement during the unilateral PKP procedure could prevent serious leakage and clinical symptoms.

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Section: Discussionmentioning

confidence: 99%

“…[5–7] Cement leaking into the disc is found to increase the risk of new fractures of adjacent vertebral bodies. [8] In OCVFs with compromised vertebral body walls, the risk seemed to be higher as surgical maneuvers may further aggravate cortical fragments.…”

Section: Introductionmentioning

confidence: 99%

Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery

Li¹,

Li²,

Qing-jun³

et al. 2017

Medicine

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“…In this report we describe one patient with an incomplete osteoporotic burst fracture (AO type A3.1) and another patient with an AO type A1.3 fracture. Walter et al evaluated the frequency of complication with regard to the fracture type, and suggested that BKP can be considered as a safe procedure, even in the treatment of painful osteoporotic vertebral fractures of AO type A3.1 [14]. Our current case report demonstrates a cause of delayed neurological decline in those that undergoing BKP.…”

Section: Discussionmentioning

confidence: 60%

Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture: a report of two cases

et al. 2012

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PurposeTo describe two unique cases of osteoporotic vertebral compression fracture (OVCF) treated with balloon kyphoplasty (BKP) that were complicated by spinal instability and resultant lower extremity paraparesis.MethodsKyphoplasty was performed in two patients with OVCF that had persistent back pain despite a course of conservative care. Immediately following BKP, both patients had a marked improvement in back pain. However, they developed progressive bilateral lower extremity weakness. Lateral spine flexion–extension radiographs demonstrated instability, and polymethyl methacrylate did not adhere to the endplate of the treated vertebrae.ResultsBoth the patients underwent a hybrid fixation without a decompression. Postoperatively, both of them demonstrated gradual improvement in their neurological exam.ConclusionsTo the best of our knowledge, this is the first report describing the development of spinal instability with resultant delayed paraplegia following BKP. This case report demonstrates another cause of neurological decline following BKP, in the absence of cement leakage.

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“…With the cementless application of the expandable titanium mesh cage, we did not see any of these complications leading to favorable results in complication rates when compared to standard methods [19, 20]. …”

Section: Discussionmentioning

confidence: 94%

“…This seems problematic, since, even after minor traumata, VCFs are amenable for involvement of the dorsal wall [14]. When taking this into consideration, cement-based treatment algorithms for VCF care are likely to induce cement-associated complications like leakage in the disc space or epidural space in more severe fracture types like burst fractures with dorsal wall involvement [15–20]. …”

Section: Introductionmentioning

confidence: 99%

Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Eschler

Ender

Ulmar

et al. 2014

BioMed Research International

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Introduction. Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. Methods. Four patients (72.3 years, range 70–76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24–28). Results. Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. Conclusion. Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS).

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Cement leakage as a possible complication of balloon kyphoplasty—is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?

Cited by 45 publications

References 28 publications

Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery

Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery

Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture: a report of two cases

Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

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