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Vertebroplasty Complications
Bryson Borg, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Vertebroplasty
              • Placement of polymethylmethacrylate (PMMA) into compressed vertebral body to stabilize fracture
            • Kyphoplasty
              • Injection of PMMA preceded by balloon inflation within vertebral body
                • Restore vertebral body height
                • Reduce kyphotic deformity
                • Create cavity to facilitate injection of cement under low pressure

          IMAGING

          • General Features

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Gross Pathologic & Surgical Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          Selected References

                          1. Xiao H et al: Comparing complications of vertebroplasty and kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis of the randomized and non-randomized controlled studies. Eur J Orthop Surg Traumatol. ePub, 2014
                          2. Agrawal G et al: Mismatched perfusion defects secondary to recent methyl methacrylate embolization. Clin Nucl Med. 38(1):50-2, 2013
                          3. Al-Ali F et al: Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol. 30(10):1835-9, 2009
                          4. Popa RI et al: Urinary tract infections in the potential vertebroplasty patient: incidence, significance, and management. AJNR Am J Neuroradiol. 30(2):227-31, 2009
                          5. Syed MI et al: Fatal fat embolism after vertebroplasty: identification of the high-risk patient. AJNR Am J Neuroradiol. 27(2):343-5, 2006
                          6. Trout AT et al: Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol. 27(7):1397-403, 2006
                          7. Appel NB et al: Percutaneous vertebroplasty in patients with spinal canal compromise. AJR Am J Roentgenol. 182(4):947-51, 2004
                          8. Brown DB et al: Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol. 182(2):319-22, 2004
                          9. Lin EP et al: Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 25(2):175-80, 2004
                          10. Stricker K et al: Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty. Anesth Analg. 98(4):1184-6, table of contents, 2004
                          11. Baroud G et al: Biomechanical explanation of adjacent fractures following vertebroplasty. Radiology. 229(2):606-7; author reply 607-8, 2003
                          12. Childers JC Jr: Cardiovascular collapse and death during vertebroplasty. Radiology. 228(3):902; author reply 902-3, 2003
                          13. Evans AJ et al: Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 226(2):366-72, 2003
                          14. Gangi A et al: Percutaneous vertebroplasty: indications, technique, and results. Radiographics. 23(2):e10, 2003
                          15. Hodler J et al: Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology. 227(3):662-8, 2003
                          16. Kang JD et al: Cement augmentation of osteoporotic compression fractures and intraoperative navigation: summary statement. Spine. 28(15):S62-3, 2003
                          17. Kelekis AD et al: Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the "cooling system". Spine. 28(14):E265-9, 2003
                          18. Koessler MJ et al: Fat and bone marrow embolism during percutaneous vertebroplasty. Anesth Analg. 97(1):293; author reply 294, 2003
                          19. Mathis JM: Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol. 24(8):1697-706, 2003
                          20. Mousavi P et al: Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae. J Neurosurg. 99(1 Suppl):56-9, 2003
                          21. Sarzier JS et al: Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 24(5):1001-2, 2003
                          22. Shapiro S et al: Surgical removal of epidural and intradural polymethylmethacrylate extravasation complicating percutaneous vertebroplasty for an osteoporotic lumbar compression fracture. Case report. J Neurosurg. 98(1 Suppl):90-2, 2003
                          23. Stallmeyer MJ et al: Optimizing patient selection in percutaneous vertebroplasty. J Vasc Interv Radiol. 14(6):683-96, 2003
                          24. Tsai TT et al: Polymethylmethacrylate cement dislodgment following percutaneous vertebroplasty: a case report. Spine. 28(22):E457-60, 2003
                          25. Uppin AA et al: Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 226(1):119-24, 2003
                          26. Yeom JS et al: Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br. 85(1):83-9, 2003
                          27. Aebli N et al: Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine (Phila Pa 1976). 27(5):460-6, 2002
                          28. Moreland DB et al: Vertebroplasty: techniques to avoid complications. Spine J. 1(1):66-71, 2001
                          29. Patterson BM et al: Cardiac arrest during hip arthroplasty with a cemented long-stem component. A report of seven cases. J Bone Joint Surg Am. 73(2):271-7, 1991
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Imaging

                            • Pathology

                              • Clinical Issues

                                • Diagnostic Checklist

                                  TERMINOLOGY

                                  • Definitions

                                    • Vertebroplasty
                                      • Placement of polymethylmethacrylate (PMMA) into compressed vertebral body to stabilize fracture
                                    • Kyphoplasty
                                      • Injection of PMMA preceded by balloon inflation within vertebral body
                                        • Restore vertebral body height
                                        • Reduce kyphotic deformity
                                        • Create cavity to facilitate injection of cement under low pressure

                                  IMAGING

                                  • General Features

                                    • Imaging Recommendations

                                      DIFFERENTIAL DIAGNOSIS

                                        PATHOLOGY

                                        • General Features

                                          • Gross Pathologic & Surgical Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Demographics

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  Selected References

                                                  1. Xiao H et al: Comparing complications of vertebroplasty and kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis of the randomized and non-randomized controlled studies. Eur J Orthop Surg Traumatol. ePub, 2014
                                                  2. Agrawal G et al: Mismatched perfusion defects secondary to recent methyl methacrylate embolization. Clin Nucl Med. 38(1):50-2, 2013
                                                  3. Al-Ali F et al: Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol. 30(10):1835-9, 2009
                                                  4. Popa RI et al: Urinary tract infections in the potential vertebroplasty patient: incidence, significance, and management. AJNR Am J Neuroradiol. 30(2):227-31, 2009
                                                  5. Syed MI et al: Fatal fat embolism after vertebroplasty: identification of the high-risk patient. AJNR Am J Neuroradiol. 27(2):343-5, 2006
                                                  6. Trout AT et al: Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol. 27(7):1397-403, 2006
                                                  7. Appel NB et al: Percutaneous vertebroplasty in patients with spinal canal compromise. AJR Am J Roentgenol. 182(4):947-51, 2004
                                                  8. Brown DB et al: Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol. 182(2):319-22, 2004
                                                  9. Lin EP et al: Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 25(2):175-80, 2004
                                                  10. Stricker K et al: Severe hypercapnia due to pulmonary embolism of polymethylmethacrylate during vertebroplasty. Anesth Analg. 98(4):1184-6, table of contents, 2004
                                                  11. Baroud G et al: Biomechanical explanation of adjacent fractures following vertebroplasty. Radiology. 229(2):606-7; author reply 607-8, 2003
                                                  12. Childers JC Jr: Cardiovascular collapse and death during vertebroplasty. Radiology. 228(3):902; author reply 902-3, 2003
                                                  13. Evans AJ et al: Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 226(2):366-72, 2003
                                                  14. Gangi A et al: Percutaneous vertebroplasty: indications, technique, and results. Radiographics. 23(2):e10, 2003
                                                  15. Hodler J et al: Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology. 227(3):662-8, 2003
                                                  16. Kang JD et al: Cement augmentation of osteoporotic compression fractures and intraoperative navigation: summary statement. Spine. 28(15):S62-3, 2003
                                                  17. Kelekis AD et al: Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the "cooling system". Spine. 28(14):E265-9, 2003
                                                  18. Koessler MJ et al: Fat and bone marrow embolism during percutaneous vertebroplasty. Anesth Analg. 97(1):293; author reply 294, 2003
                                                  19. Mathis JM: Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol. 24(8):1697-706, 2003
                                                  20. Mousavi P et al: Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae. J Neurosurg. 99(1 Suppl):56-9, 2003
                                                  21. Sarzier JS et al: Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 24(5):1001-2, 2003
                                                  22. Shapiro S et al: Surgical removal of epidural and intradural polymethylmethacrylate extravasation complicating percutaneous vertebroplasty for an osteoporotic lumbar compression fracture. Case report. J Neurosurg. 98(1 Suppl):90-2, 2003
                                                  23. Stallmeyer MJ et al: Optimizing patient selection in percutaneous vertebroplasty. J Vasc Interv Radiol. 14(6):683-96, 2003
                                                  24. Tsai TT et al: Polymethylmethacrylate cement dislodgment following percutaneous vertebroplasty: a case report. Spine. 28(22):E457-60, 2003
                                                  25. Uppin AA et al: Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 226(1):119-24, 2003
                                                  26. Yeom JS et al: Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br. 85(1):83-9, 2003
                                                  27. Aebli N et al: Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine (Phila Pa 1976). 27(5):460-6, 2002
                                                  28. Moreland DB et al: Vertebroplasty: techniques to avoid complications. Spine J. 1(1):66-71, 2001
                                                  29. Patterson BM et al: Cardiac arrest during hip arthroplasty with a cemented long-stem component. A report of seven cases. J Bone Joint Surg Am. 73(2):271-7, 1991