Extravertebral cement leakage at percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures

Abstract

Objective. Investigation of the frequency, peculiarities and clinical signs of extravertebral cement leakage (ECL) during baloon kyphoplasty in patients with osteoporotic vertebral compression fractures (OVCF).Material and methods. A retrospective analysis of 24 patients with OVCF, aged 57 to 82 years (average 71 years old), 19 females and 5 males; 47 vertebral bodies treated. MSCT and all available intrascopic examinations data were evaluated. Doubtful signs were interpreted as ECL. Cement extravasations were divided for leakage into venous plexuses (VP) and through cortical bone defects (CBD).Results. ECL were found in 48.9 % of cases; in one patient bone cement was determined in small branches of the pulmonary artery. The frequencies of ECL into the venous plexuses and through cortical defects were approximately the same (27.6 and 31.9 %, respectively), combined distribution — 4.2 %. Leakage into the intervertebral discs (17 %) probably did not cause adjacent vertebral fractures. Clinical symptoms were detected only for cement distribution into the epidural and radicular veins (25 %, 1 of 4 cases) and trough CBD into the vertebral canal (1 case). Cement embolism of the pulmonary arteries (1 patient) were not accompanied by TEPA.Conclusions. MSCT after kyphoplasty provides precise identification of presence and the features of ECL. Complications of ECL occur predominantly when cement enters the vertebral canal or intervertebral venous plexuses, but there are potential high risks for cement distribution into major venous vessels. ECL itself should not be considered as a complication of kyphoplasty.