Polymethylmethacrylate Cement Dislodgment Following Percutaneous Vertebroplasty: A Case Report

Self Cite

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.

Section: Discussionmentioning

confidence: 99%

“…Delayed sequelae are also reported, such as adjacent vertebral fracture, cement dislodgement or fragmentation, and pyogenic spondylitis [1,7,25,27,33,34]. Most of these complications can be resolved by conservative treatment, but in some circumstances, surgical intervention is indicated.…”

Section: Introductionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

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“…Recollapse of the treated vertebrae and PMMA cement dislodgment after percutaneous vertebroplasty were reported as early complications with the predisposing factor of pre-operative ON [22][23][24]. Thus, it is important to obtain the diagnosis of vertebral ON prior to making a decision on treatment, since it should be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

Lin

Huang

et al. 2012

Introduction Magnetic resonance images (MRI) fluid sign and intravertebral vacuum phenomenon of the plain radiograph are considered as the characteristic radiological findings for vertebral osteonecrosis after spinal fractures. We aim to study the association between the radiological and histopathologic findings of vertebral osteonecrosis through the use of an open retrieval of specimens. Materials and methods Twenty consecutive patients (54-84 years, mean 73 years) of unstable vertebral compression fractures treated with anterior corpectomy and fusion were included. All the images and pathologies were correlated, especially the histopathologic changes to the fluid sign and vacuum phenomenon.Results MRI fluid signs and the histopathologic findings of vertebral osteonecrosis were significantly correlated and both were noted in the first 5 months after injury. The power of the fluid sign in diagnosing vertebral osteonecrosis was better than that of the intravertebral vacuum phenomenon (diagnostic odds ratio 65 vs. 2, sensitivity 86 vs. 50 %, specificity 100 vs. 67 %). Conclusion MRI fluid sign is more predictable to diagnose vertebral osteonecrosis in operative case, especially within the initial 5 months after injury.

“…A doughy cement and low-pressure procedure may prevent good bone-cement interdigitation [25,42] and cause long-term loosening of the cement block. In Kü mmell's disease [21,26], there are fibrocartilaginous membranes [21] on the fracture surface, which may prevent cement-bone interdigitation and could lead to cement loosening and dislodgement [47]. However, mature techniques and the appropriate timing of cement application is hard to coordinate in general practice.…”

Section: Introductionmentioning

confidence: 99%

Transpedicle body augmenter in painful osteoporotic compression fractures

Hsieh

et al. 2006

Osteoporotic compression fractures (VCFs) can result in progressive kyphosis and chronic pain. Polymethylmethacrylate has been used for augmentation of VCFs; however, there are cement complications, and long-term fracture healing is unknown. The transpedicle body augmenter (TpBA), a porous titanium spacer, has been reported as an internal support to reconstruct the vertebral body combining short segment fixation in burst fracture. We retrospectively reviewed radiographic and clinical results of TpBA vertebroplasty for single symptomatic VCF in 80 patients. Manual reduction and TpBA vertebroplasty via a paramedian incision with blunt dissection was done. Mean age was 72.3 years (range 51-87 years), and female-male ratio was 66:14. The mean symptom duration was 5 months, and follow-up 44 months. Peri-operative variables and radiographic and clinical results were evaluated. The average operation time was 26