Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature

Background context: Percutaneous augmentation with bone cement is a widely accepted modality of treatment for thoracic and lumbar vertebral osteoporotic fractures. Infection after vertebroplasty or kyphoplasty is a serious, yet, rarely reported complication.

Purpose: To present a case series with a long-term follow-up of spinal infection after vertebroplasty/kyphoplasty with analysis of preoperative condition, risk factors, diagnostic findings, time before reoperation, causative organism, treatment, and outcome.

Study design: A retrospective, uncontrolled clinical case series in a single institution.

Patient sample: Between January 1997 and June 2012, 1,307 patients underwent percutaneous vertebroplasty or kyphoplasty. Six cases had postoperative infection (0.46%) and three additional cases were referred from other institutions for salvage treatment.

Outcome measures: Perioperative assessment included visual analog scale, clinical, laboratory, and imaging findings, and activities of daily living at the end of the follow-up.

Methods: Nine patients were included: six females and three males (mean age 73.8 years). Comorbidities were found in all patients. Kyphoplasty had been done in five patients and vertebroplasty in four.

Results: The interval between augmentation and revision surgery ranged from 10 to 395 days with a mean of 118.4 days. Three cases with early infection presented within 1 month. Infection parameters were high in all patients at readmission. All patients were treated surgically except one case who died before the planned revision surgery. In all cases, debridement and corpectomy were done through anterior approaches combined with posterior instrumentation. The most common causative organism was Staphylococcus aureus in three cases. Mean follow-up period after the revision surgery was 26.68 months, excluding two patients who died early in the follow-up (within 4 months). This amounts to a mortality rate of 33.3% perioperatively. At the end of follow-up, two patients had unrestricted activities and one patient required a walker. Of three paraparetic patients, two improved functionally and could walk unassisted and one improved but still used a wheelchair.

Conclusions: Although vertebroplasty and kyphoplasty are minimally invasive interventions, postoperative infection can develop into life-threatening complications. This should be accounted for, in decision making in the elderly age group most commonly affected by osteoporotic fractures and especially in suspicious and high-risk immune-compromised patients.