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Cement leakage as a possible complication of balloon kyphoplasty—is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?

  • Clinical Article
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Abstract

Background

Besides the treatment of osteoporotic vertebral compression fractures of AO type A1, balloon kyphoplasty (BKP) is seen as a therapeutic option even in the treatment of incomplete osteoporotic burst fractures (AO type A3.1). However, due to involvement of the posterior vertebral body wall, the risk of cement leakages is considered to be higher. This study focuses on the frequency and pattern of cement leakages in AO type A3.1 fractures compared with osteoporotic compression fractures (AO type A1).

Patients and methods

Retrospective cohort analysis was done of all patients (n = 138) treated by BKP for osteoporotic vertebral fractures (n = 173) between January 2007 and December 2010 in our department. Cement extravasations into three pre-defined anatomical compartments were evaluated on postoperative CT scans of the augmented vertebral bodies, with even minor cement detections beyond the vertebral body’s wall being strictly inidicated as leakages. The frequency of cement leakages in relation to the fracture type was statistically analyzed using Pearson's chi-square test. Clinical and radiological follow-up was done 6 weeks, 3 and 6 months postoperatively.

Results

The overall cement leakage rate of BKP in 173 treated osteoporotic vertebral fractures was 30.6%. Cement extravasations were detected in 20.3% of A1.1, 30.5% of A1.2, 37.8% of A1.3, and 39.0% of A3.1 fractures, respectively. There was no statistically significant difference in the leakage rate between A3.1 and all A1 fractures (28.0%; p > 0.05), but between A3.1 and A1.1 fractures (p < 0.05). Intraspinal cement extravasations, being the most dangerous, were seen in 25.5% of all leakages (n = 53), whereas in relation to the total number of treated fracture types, there were only 5.1% intraspinal leakages in A1.1, 5.6% in A1.2, 10.9% in A1.3, and 9.8% in A3.1 fractures. Two of 13 patients with intraspinal leakages and 1 patient with a paraaortal anterolateral cement extravasation needed surgical revisions. Two pulmonary PMMA cement embolisms were detected, but without any clinical consequences. None of the patients with cement leakages during BKP suffered from new neurological deficits.

Conclusions

Cement leakages remain a problem in BKP. Although there was no significant difference between AO type A3.1 and all A1 fractures, subgroup analysis revealed a statistically significant higher risk of cement extrusions in A3.1 compared to A1.1 fractures. None of the affected patients showed new neurological deficits due to cement extravasations. Still, balloon kyphoplasty can be considered a safe procedure, even in the treatment of painful osteoporotic vertebral fractures of AO type A3.1.

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References

  1. Becker S, Garoscio M, Meissner J, Tuschel A, Ogon M (2007) Is there an indication for prophylactic balloon kyphoplasty? A pilot study. Clin Orthop Relat Res 458:83–89

    Google Scholar 

  2. Bouza C, López T, Magro A, Navalpotro L, Amate JM (2006) Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J 15(7):1050–1067

    Article  PubMed  Google Scholar 

  3. Bouza C, López-Cuadrado T, Cediel P, Saz-Parkinson Z, Amate JM (2009) Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis. BMC Palliat Care 8:12

    Article  PubMed  Google Scholar 

  4. Cortet B, Chastanet P, Laredo JD (2010) Osteoporotic vertebral fractures: a role for vertebroplasty or kyphoplasty? Joint Bone Spine 77(5):380–381

    Article  PubMed  Google Scholar 

  5. Dalbayrak S, Onen MR, Yilmaz M, Naderi S (2009) Clinical and radiographic results of balloon kyphoplasty for treatment of vertebral body metastases and multiple myelomas. J Clin Neurosci 17(2):219–224

    Article  PubMed  Google Scholar 

  6. Eck JC, Nachtigall D, Humphreys SC, Hodges SD (2008) Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 8(3):488–497

    Article  PubMed  Google Scholar 

  7. Gaitanis IN, Hadjipavlou AG, Katonis PG, Tzermiadianos MN, Pasku DS, Patwardhan AG (2005) Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur Spine J 14(3):250–260

    Article  PubMed  Google Scholar 

  8. Garfin SR, Buckley RA, Ledlie J (2006) Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine 31(19):2213–2220

    Article  PubMed  Google Scholar 

  9. Hartmann F, Gercek E, Leiner L, Rommens PM (2010) Kyphoplasty as an alternative treatment of traumatic thoracolumbar burst fractures Magerl type A3. Injury. [epub ahead of print doi: 10.1016/j.injury.2010.03.025]

  10. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31:1983–2001

    Article  PubMed  Google Scholar 

  11. Jin YJ, Yoon SH, Park KW, Chung SK, Kim KJ, Yeom JS, Kim HJ (2011) The volumetric analysis of cement in vertebroplasty: relationship with clinical outcome and complications. Spine 36(12):E761–E772

    Article  PubMed  Google Scholar 

  12. Krueger A, Bliemel C, Zettl R, Ruchholtz S (2009) Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J 18(9):1257–1265

    Article  PubMed  Google Scholar 

  13. Krueger A, Zettl R, Ziring E, Mann D, Schnabel M, Ruchholtz S (2010) Kyphoplasty for the treatment of incomplete osteoporotic burst fractures. Eur Spine J 19(6):893–900

    Article  Google Scholar 

  14. Ledlie JT, Renfro MB (2006) Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits. Spine 31(1):57–64

    Article  PubMed  Google Scholar 

  15. Lee IJ, Choi AL, Yie MY, Yoon JY, Jeon EY, Koh SH, Yoon DY, Lim KJ, Im HJ (2010) CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty. Acta Radiol 51(6):649–654

    Article  PubMed  Google Scholar 

  16. Lee MJ, Dumonski M, Cahill P, Stanley T, Park D, Singh K (2009) Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine 34(11):1228–1232

    Article  PubMed  Google Scholar 

  17. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201

    Article  PubMed  CAS  Google Scholar 

  18. McArthur N, Kasperk C, Baier M, Tanner M, Gritzbach B, Schoierer O, Rothfischer W, Krohmer G, Hillmeier J, Kock HJ, Meeder PJ, Huber FX (2009) 1150 kyphoplasties over 7 years: indications, techniques, and intraoperative complications. Orthopedics 32(2):90

    PubMed  Google Scholar 

  19. McCall T, Cole C, Dailey A (2008) Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events. Curr Rev Musculoskelet Med. (1):17–23.

  20. McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9(6):501–508

    Article  PubMed  Google Scholar 

  21. Mirovsky Y, Anekstein Y, Shalmon E, Blankstein A, Peer A (2006) Intradiscal cement leak following percutaneous vertebroplasty. Spine 31:1120–1124

    Article  PubMed  Google Scholar 

  22. Röllinghoff M, Siewe J, Zarghooni K, Sobottke R, Alparslan Y, Eysel P, Delank KS (2009) Effectiveness, security and height restoration on fresh compression fractures–a comparative prospective study of vertebroplasty and kyphoplasty. Minim Invasive Neurosurg 52(5–6):233–237

    Article  PubMed  Google Scholar 

  23. Röllinghoff M, Zarghooni K, Schlüter-Brust K, Sobottke R, Schlegel U, Eysel P, Delank KS (2010) Indications and contraindications for vertebroplasty and kyphoplasty. Arch Orthop Trauma Surg 130(6):765–774

    Article  PubMed  Google Scholar 

  24. Ryu KS, Park CK, Kim MC, Kang JK (2002) Dose-dependent epidural leakage of polymethyl methacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg Spine 96:56–61

    Article  Google Scholar 

  25. Schmidt-Rohlfing B, Reilmann H, Pfeifer R, Kobbe P, Pape HC (2011) Kyphoplasty and vertebroplasty : Indications, techniques, complications and results. Unfallchirur. [epub ahead of print doi:10.1007/s00113-011-2013-y

  26. Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 16:1085–1100

    Article  PubMed  Google Scholar 

  27. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31(23):2747–2755

    Article  PubMed  Google Scholar 

  28. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Jan Walter, Ersin Haciyakupoglu, Albrecht Waschke, Rolf Kalff & Christian Ewald

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  1. Jan Walter
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  2. Ersin Haciyakupoglu
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  3. Albrecht Waschke
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  4. Rolf Kalff
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  5. Christian Ewald
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Correspondence to Jan Walter.

Additional information

Jan Walter and Ersin Haciyakupoglu contributed equally to this work

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Walter, J., Haciyakupoglu, E., Waschke, A. et al. Cement leakage as a possible complication of balloon kyphoplasty—is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?. Acta Neurochir 154, 313–319 (2012). https://doi.org/10.1007/s00701-011-1239-3

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  • DOI: https://doi.org/10.1007/s00701-011-1239-3

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