Radicular pain after vertebroplasty: complication and prevention

Excerpt

I very much enjoyed the interesting article by Laredo and Hamze [1] on the possible complications of vertebroplasty. It is an important document, showing the interventional radiologist how to manage complications. I was though, very surprised by the authors’ position on foraminal leakage. The authors logically state that “Cement leakage into the foramen ... is less frequent since the transpedicular approach is preferred to the classical posterolateral approach which crosses the foramen. Both foraminal and spinal canal cement leakage may be due to breaking through the medial or inferior cortex of the vertebral pedicle at the time of approach” and later mention that “Foraminal leakage of PMMA may be due to a number of causes including pre-existing cortical destruction, inadequate needle puncture hole with inadvertent cortical perforation, inadequate needle approach passing through the neural foramina, reflux of cement along the needle track in cases of posterolateral needle approach and cement leakage into the foraminal veins. Some cases of induced radiculopathy are managed by systemic corticosteroids and nerve root block while surgical decompression is needed in other cases”, but do not comment on the fact that foraminal leakage may come from the epidural plexus [2]. It is even more surprising that the authors do not include our paper in their references and do not comment that, apart from compression, a small quantity of cement can create radicular pain, possibly due to shock (thermal or chemical) to the root [2]. The authors also make no mention of the possibility of direct foraminal infusion as described in our paper, directly when a leakage is seen and pain develops [2], which can be an alternative to frustrating infiltrations or surgery [3, 4]. I believe that it is important to consider invasive techniques as possible solutions to clinical problems on the spot, before relaying the complications to our fellow surgeons. …