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Patterns of extravertebral polymethylmethacrylate (PMMA) leak after Vertebroplasty and Kyphplasty 2007

Interventional Spine

Farbod Nasseri, M.D.
Hani A Haykal, M.D., Non ASSR Member

Scientific Poster

Exhibit Panels: 1

Purpose

The purpose of this exhibit is to present specific patterns of extra-vertebral PMMA leakage in Vertebroplasty and Kyphoplasty. During Vertebroplasty and Kyphoplasty, bone filler (PMMA) is introduced into a fractured vertebral body in an attempt to stabilize the fracture. During Vertebroplasty, the high-pressure injection of low-viscosity cement directly into cancellous bone makes it difficult to control the PMMA flow in the vertebral body, thus creating an unpredictable risk of PMMA extravasation outside the vertebral body. An alternative procedure, balloon kyphoplasty, involves the percutaneous placement of an inflatable bone tamp into the fractured vertebral body. As the tamp is inflated, vertebral body height is restored and a cavity is created within the vertebral body, allowing for low-pressure PMMA filling of the cavity.

Methods & Materials

We retrospectively reviewed 182 Vertebroplasty and 667 Kyphoplasty procedures at our institution from August 2001 to October 2006. There were 153 patients who underwent Vertebroplasty and 441 patients who underwent Kyphoplasty. There were 196 vertebrae treated by Vertebroplasty and 731 vertebra treated with Kyphoplasty. The final films after the procedure were reviewed and extra-vertebral leak of PMMA was noted.

Results

Extra-vertebral leakage was documented and classified as spinal epidural, spinal transforaminal, venous epidural, intradiscal, paravertebral. Other leaks were classified as miscellaneous.

Conclusion

Extra-vertebral PMMA leaks are noted in both Vertebroplasty and Kyphoplasty. There appears to be a higher rate of leakage for Vertebroplasty than Kyphoplasty. Leakage patterns are different for Vertebroplasty compared to Kyphoplasty.

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