Vertebroplasty and Kyphoplasty. Complications, Avoidance, and Technical Notes in our 7 Years' Experience

Introduction The vertebroplasty (VP) and kyphoplasty (KP) are well known methods for the treatment of vertebral bodies fractures, due osteoporosis, primary, and metastatic tumor. The major complications are the cord and root compression, due cement leakage, epidural and subdural hematomas, and pulmonary emboli. These complications are most described in VP. In this retrospective study, the authors describe the way they find to avoid major complications with KP and a modification of de VP technique. Patients and Methods Between January 2007 and July 2014, 138 patients with 184 levels were treated in the three institutions. In 124 levels, KP was performed and in 60 levels VP. Balloon KP with pressure manometer was used. The VP were performed using de bone feelers and the cannulas of the KP set, without the insufflation of the balloon. A retrospective analysis of the cases was made and a review of the literature. Results A total of 102 patients (73.9%) were females and 36 patients (26.1%) were males. The 69% of the total of patients were single fractures and 31% were double level fractures. The etiology was 92% osteoporotic fractures, four patients (2.9%) underwent KP due multiple myeloma, five patients (3.6%) for hemangioma, and two patients (1.4%) for spinal metastasis. Pain relief was reported in all the patients with a media of VAS 8 of 10 in pre-op and VAS 2 of 10 in post-op. Neither major complications nor post-op infections were reported. Overall, 3 patients with cement leakage in the spinal canal, 14 patients with interbody disc space leakage, and 9 patients with lateral and anterior extravasations were described without symptoms. Conclusion The cement injection with the bone fillers provides more control in the cement infusion in the VP as well as in the KP, avoiding the leakage of cement in great quantity and preventing major complications.