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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2019

Open Access 01-12-2019 | Research article

Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty

Authors: Ming-Kai Hsieh, Fu-Cheng Kao, Ping-Yeh Chiu, Lih-Huei Chen, Chia-Wei Yu, Chi-Chien Niu, Po-Liang Lai, Tsung-Ting Tsai

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

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Abstract

Background

The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated.

Methods

Three thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded.

Results

Type-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support.

Conclusions

Cement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.
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Metadata
Title
Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty
Authors
Ming-Kai Hsieh
Fu-Cheng Kao
Ping-Yeh Chiu
Lih-Huei Chen
Chia-Wei Yu
Chi-Chien Niu
Po-Liang Lai
Tsung-Ting Tsai
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-019-1459-4

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