Preventing Neurologic Injuries After Vertebroplasty or Kyphoplasty
Vertebroplasty and kyphoplasty are two similar surgical treatments for spinal factures caused by osteoporosis. In both these procedures, cement is injected into the fractured vertebral body. In the case of kyphoplasty, a balloon is inserted into the bone first. The balloon is inflated, removed, and then glue is injected inside the vertebral body.

The treatment is both safe and effective. But some cases of neurologic problems have been reported. A review of 14 cases of neurologic injury after kyphoplasty or vertebroplasty was reported in this study.

Some patients had severe back pain and leg weakness within 24 hours of the operation. Others developed these same symptoms more slowly (anywhere from three days to three months later).

Surgery was done right away for patients who reported severe back pain and weakness within 24 hours of the kyphoplasty. Anyone who couldn't have surgery because of serious health issues was observed for 48 hours before initiating surgery.

Although this procedure has become very popular, surgeons should keep in mind there are serious complications possible. Infection, rib fractures, and blood clots top the list of possibilities. Cement oozing out of the bone and irritating the nerve structures is another potential problem. And the bone above or below the vertebral compression fracture (VCF) can also break or shatter.

The authors provide several suggestions for ways to prevent injury from either of these operations. First, the right patients must be selected for the treatment. Patients with burst fractures are not always good candidates for this operation.

Second, when this procedure is used for burst fractures, the balloon catheter is placed in the front of the bone. This seems to help contain the cement and keep it from oozing back out. Using a smaller amount of cement also seems to help.

Some surgeons have suggested the use of a bladder or lining to hold the cement in place. Others have proposed making the cement thicker and faster absorbing.

Surgeons should be reminded that neurologic complications can occur early or late with either of these operations. Recognizing the problem right away can help reduce the long-term effects.
Alpesh A. Patel, MD, et al. Neurologic Deficit Following Percutaneous Vertebral Stabilization. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1728-1734.