Roman Kloeckner MED, Presenter: Nothing to Disclose

Jens Schneider MD, Abstract Co-Author: Nothing to Disclose

Christopher Markus Ahlers MD, Abstract Co-Author: Nothing to Disclose

Phillip Drees MD, Abstract Co-Author: Nothing to Disclose

Christoph Dueber MD, Abstract Co-Author: Nothing to Disclose

Michael Bernhard Pitton MD, Abstract Co-Author: Nothing to Disclose

To analyse the technical results, extraosseous cement leakages, and complications in 500 vertebroplasty procedures.

Osteoporotic vertebral compression fractures or osteolytic lesions were treated with CT-guided vertebroplasty. Technical results, extraosseous cement leakages and secondary fractures were documented by MDCT and clinical complications were analyzed.

500 vertebroplasty procedures were performed in 251 patients (82 male, 169 female, 71.5±9.8 years, osteoporotic n=217, osteolytic tumor n=34). The numbers of vertebrae treated per patient, interventions per patient, and interventions per vertebra were 1.96±1.29, 1.33±0.75 and 1.01±0.10. Cement volume was 4.5±1.9ml. 30-day mortality was 0.4% (1/251) due to pulmonary cement embolism. Procedure-related morbidity was 2.8% (7/251), including acute coronary syndrome (n=1), missing patellar reflex (n=1), medullary conus syndrome after nocturnal downfall (n=1), inadequate conscious sedation (n=2), one pedicle and one rib fracture. MDCT-based cement leak rate was 55.4% and included leakages into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow-up (15.2±13.4 months) secondary fracture rate was 17.1%, including comparable numbers for vertebrae at adjacent and distant levels. Presence of intradiscal cement leaks was not associated with increased adjacent fracture rates.

CT-guided vertebroplasty is safe and effective for treatment of vertebral compression fractures. CT-fluoroscopy provides excellent control over the posterior vertebral wall. Number of cement leaks is not directly associated with clinical complications. However, even small volumes of pulmonary PMMA embolism might be associated with fatal outcome in cases of underlying cardiopulmonary insufficiency.

The work shows that vertebroplasty is a safe and effective treatment but also that close surveillance is mandatory immediately after treatment due to the possibility of extraosseous cement leakages.

Kloeckner, R, Schneider, J, Ahlers, C, Drees, P, Dueber, C, Pitton, M, CT-guided Vertebroplasty: Analysis of Technical Results, Extraosseous Cement Leakages, and Complications in 500 Vertebroplasty Procedures.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012828.html