Revision strategies for complications and failure of vertebroplasties

Abstract

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.

Role of ‘low cost Indian implants’ in our practice: our experience with 1,572 pedicle screws

“…Osteoporosis is one factor which should always be accounted in the preoperative planning [3,4]. As surgeons, we have the options of using sublaminar wires (unpublished data), hooks [5], or cement augmented screws [6,7] in severely osteoporotic cases. In addition, the least we can do is to investigate these patients with bone densitometry and start them on anti osteoporotic treatment.…”

Nonaneurysmal Subarachnoid Hemorrhage : Rare Complication of Vertebroplasty

“…However, it has been suggested that this minor intervention can be complex with procedure-related complications that may affect the spinal column itself and extraspinal systems occur acutely or lately 9,17) . Fortunately, most complications of PV are minor and infrequent.…”

“…As a spinal complication following PV, new fractures at adjacent vertebrae, spinal roots and cord injury, neuritis, intramuscular and spinal epidural hematoma, infectious and inflammatory spondylodiscitis, spinal cord compression, and extravertebral cement leakage have been well-known 2,3) . Furthermore, this spinal procedure cannot be safe with unexpected events such as, chest contusion, rib fracture, pneumothorax, cement pulmonary embolus, stab injury to major vessels and pleurae, leg venous thrombosis, and problem of anesthesia 4,9,17) . Fortunately, however, extraspinal complication of vertebroplasty occurred remote from the puncture site is rare.…”

Kyphoplasty and intra-operative radiotheray, combination of kyphoplasty and intra-operative radiation for spinal metastases: technical feasibility of a novel approach

“…In the context of back-up options one must also consider local failure by recurrent or progressive metastases. In these cases it seems possible to change the surgical strategy to circumferential resection and reconstruction, as demonstrated for cement augmentation in osteoporotic cases [24]. In case of adjacent segment metastases an additional Kypho-IORT seems feasible without radiation damage due to the steep dose decrease and limited radiation field.…”