Incidence and Clinical Risk of Cement Extravasation in Adult Patients Undergoing Prophylactic Vertebroplasty During Surgical Spine Reconstruction

• Published in: World neurosurgery 2020-02, Vol.134, p.e928-e936
• Main Authors: Bohl, Michael A., Sethi, Rajiv, Leveque, Jean-Christophe
• Format: Article
• Language: English
• Subjects: Adult; Bone Cements; Cervical Vertebrae - surgery; Extravasation of Diagnostic and Therapeutic Materials - complications; Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging; Extravasation of Diagnostic and Therapeutic Materials - epidemiology; Heart Atria - diagnostic imaging; Heart Ventricles - diagnostic imaging; Humans; Incidence; Lumbar Vertebrae - surgery; Osteotomy; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Pulmonary Artery - diagnostic imaging; Spinal Diseases - surgery; Spinal Fractures - prevention & control; Spinal Fusion; Spinal Neoplasms - surgery; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - etiology; Thoracic Vertebrae - surgery; Tomography, X-Ray Computed; Vena Cava, Superior - diagnostic imaging; Vertebroplasty
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.11.034

To measure the incidence and severity of cement extravasation in adult patients undergoing prophylactic vertebroplasty as part of a spinal reconstruction procedure. Consecutive adult patients treated with prophylactic vertebroplasty during a spinal reconstruction procedure were reviewed over a 46-month period. Patients without a postoperative computed tomography scan were excluded. Spine reconstruction was defined as any procedure involving ≥6 levels of fusion or a 3-column osteotomy. Cement extravasation was graded using a novel grading system. Fisher exact tests were performed to identify independent predictors of cement extravasation. Inclusion and exclusion criteria were met by 34 patients comprising 112 vertebral bodies (VB). All 34 patients (100%) had computed tomography evidence of cement extravasation. Of 112 VBs, 103 (92.0%) demonstrated cement extravasation. Thirteen VBs (11.6%) in 9 patients (26.5%) had cement extending to the vena cava or end-organs or cement causing spinal canal stenosis (grade 4 and 5 extravasation). No permanent clinical sequelae were found in these 9 patients. Upper thoracic vertebrae (C7-T6) had significantly higher rates of grade 4 and 5 extravasation than lower thoracic–lumbar vertebrae (T7-L5) (P = 0.004). Although no patients in this study experienced known long-term consequences of prophylactic vertebroplasty, 26.5% of patients had cement extravasation that threatened end-organs or neural elements. These results prompted us to change our practice from cementing upper thoracic VBs to using hooks instead. Cement injection is associated with serious risks and should be performed selectively. Larger prospective studies are needed to verify these results.