Division of Spine Surgery, Department of Orthopaedics, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, India.
J Neurosurg Spine. 2012 Apr;16(4):387-93. doi: 10.3171/2011.12.SPINE11671. Epub 2012 Jan 6.
Vertebroplasty provides excellent pain relief and functional restoration for osteoporotic fractures. Short-term complications such as cement leak and embolism are well described. Incident fractures are the only well-reported long-term complications. The authors describe the cases of 5 patients who presented with back pain caused by instability or worsening neurological status 13 months (range 8-17 months) after vertebroplasty. They further classify this postvertebroplasty instability into intervertebral instability and intravertebral instability, depending on the apex of abnormal mobility. One patient presented with cement migration and progressive collapse of the augmented vertebral body. Another patient presented with an additional fracture. Both cases were classified as intravertebral instability. The cases of 3 other patients presenting with adjacent endplate erosion, vacuum disc phenomenon, and bridging osteophyte formation were classified as having intervertebral instability. Long-term effect of cements on the augmented vertebral body and adjacent endplates and discs is a cause for concern. Vertebroplasty acts as a mechanical stabilizer and provides structural support but does not bring about union. Micromotion has been shown to persist for years after vertebroplasty. This study describes persistent instability after vertebroplasty in a series of 5 cases. The authors propose that postvertebroplasty instability occurs due to collapse of soft osteoporotic bone and endplates around cement. All 3 cases of intervertebral instability were associated with an intradiscal cement leak. With increased longevity and higher functional demands of the geriatric population, the durability of this "rock (cement) between cushions (of osteoporotic bone)" arrangement (as seen in vertebroplasty) will be increasingly challenged.
椎体成形术为骨质疏松性骨折提供了极好的疼痛缓解和功能恢复。短期并发症，如水泥渗漏和栓塞，已有很好的描述。偶发骨折是唯一报道较多的长期并发症。作者描述了 5 例患者的情况，他们在椎体成形术后 13 个月（8-17 个月）出现因不稳定或神经状态恶化引起的背痛。他们根据异常活动的顶点，将这种椎体成形术后的不稳定进一步分为椎间隙不稳定和椎体内不稳定。1 例患者表现为水泥迁移和增强椎体的渐进性塌陷。另 1 例患者表现为附加骨折。这两种情况均被归类为椎体内不稳定。另外 3 例患者表现为相邻终板侵蚀、真空椎间盘现象和桥接骨赘形成，被归类为椎间隙不稳定。水泥对增强椎体和相邻终板及椎间盘的长期影响令人担忧。椎体成形术作为一种机械稳定器，提供结构支撑，但不会导致融合。研究表明，在椎体成形术后多年，微动仍会持续存在。本研究描述了 5 例病例中椎体成形术后持续不稳定的情况。作者提出，椎体成形术后不稳定是由于水泥周围的软骨质疏松性骨和终板塌陷所致。所有 3 例椎间隙不稳定均与椎间盘内水泥渗漏有关。随着老年人口的寿命延长和更高的功能需求，这种“（骨质疏松性骨）之间的水泥（像垫子一样）”排列的耐久性（如椎体成形术中所见）将越来越受到挑战。
