Cosar Murat, Sasani Mehdi, Oktenoglu Tunc, Kaner Tuncay, Ercelen Omur, Kose K Cagri, Ozer A Fahir
Department of Neurosurgery, Faculty of Medicine, Canakkale 18 March University, Canakkale, Turkey.
J Neurosurg Spine. 2009 Nov;11(5):607-13. doi: 10.3171/2009.4.SPINE08466.
Vertebroplasty is a well-known technique used to treat pain associated with vertebral compression fractures. Despite a success rate of up to 90% in different series, the procedure is often associated with major complications such as cord and root compression, epidural and subdural hematomas (SDHs), and pulmonary emboli, as well as other minor complications. In this study, the authors discuss the major complications of transpedicular vertebroplasty and their clinical implications during the postoperative course.
Vertebroplasty was performed in 12 vertebrae of 7 patients. Five patients had osteoporotic compression fractures, 1 had tumoral compression fractures, and 1 had a traumatic fracture. Two patients had foraminal leakage, 1 had epidural leakage, 1 had subdural cement leakage, 2 had a spinal SDH, and the last had a split fracture after the procedure.
Three patients had paraparesis (2 had SDHs and 1 had epidural cement leakage), 3 had root symptoms, and 1 had lower back pain. Two of the 3 patients with paraparesis recovered after evacuation of the SDH and subdural cement; however, 1 patient with paraparesis did not recover after epidural cement leakage, despite cement evacuation. Two patients with foraminal leakage and 1 with subdural cement leakage had root symptoms and recovered after evacuation and conservative treatment. The patient with the split fracture had no neurological symptoms and recovered with conservative treatment.
Transpedicular vertebroplasty may have major complications, such as a spinal SDH and/or cement leakage into the epidural and subdural spaces, even when performed by experienced spinal surgeons. Early diagnosis with CT and intervention may prevent worsening of these complications.
椎体成形术是一种用于治疗与椎体压缩性骨折相关疼痛的知名技术。尽管在不同系列研究中成功率高达90%，但该手术常伴有严重并发症，如脊髓和神经根受压、硬膜外和硬膜下血肿（SDH）、肺栓塞以及其他轻微并发症。在本研究中，作者讨论了经椎弓根椎体成形术的主要并发症及其术后临床意义。
对7例患者的12个椎体进行了椎体成形术。5例患者为骨质疏松性压缩骨折，1例为肿瘤性压缩骨折，1例为创伤性骨折。2例患者出现椎间孔渗漏，1例出现硬膜外渗漏，1例出现硬膜下骨水泥渗漏，2例出现脊髓硬膜下血肿，最后1例术后出现劈裂骨折。
3例患者出现下肢轻瘫（2例有硬膜下血肿，1例有硬膜外骨水泥渗漏），3例有神经根症状，1例有下背痛。3例下肢轻瘫患者中有2例在清除硬膜下血肿和硬膜下骨水泥后恢复；然而，1例硬膜外骨水泥渗漏的下肢轻瘫患者尽管清除了骨水泥仍未恢复。2例椎间孔渗漏患者和1例硬膜下骨水泥渗漏患者有神经根症状，经清除和保守治疗后恢复。劈裂骨折患者无神经症状，经保守治疗后恢复。
即使由经验丰富的脊柱外科医生进行经椎弓根椎体成形术，也可能出现严重并发症，如脊髓硬膜下血肿和/或骨水泥渗漏至硬膜外和硬膜下间隙。通过CT早期诊断并进行干预可防止这些并发症恶化。
