Intradiscal cement leak following percutaneous vertebroplasty

Abstract

Study design: A retrospective study to detect patients with cement leakage into the disc space following vertebroplasty.

Objective: To determine the frequency, causes, and clinical significance of cement leakage into the disc space.

Summary of background data: Much has been written about cement leakage into the epidural space following vertebroplasty but only little about intradiscal leakage.

Methods: A total of 66 patients with 1 cemented osteoporotic, fractured vertebra between T5 and L5 were followed for at least 2 years. Two of the senior authors (Y.M. and A.P.) evaluated independently cement leakage into the disc space, possible causes were investigated, and the clinical results were evaluated according to patient self-assessment.

Results: Detected in 27 patients, cement leakage into the disc space did not negatively affect patient satisfaction with the procedure. In 7 of these patients, leakage occurred through an intravertebral vacuum cleft and, in 8, through a perforation of the endplate created by the needle tip. In only 2 patients was cement found to cross the height of the vertebral body and leak into the contralateral disc.

Conclusions: Apart from iatrogenic endplate perforation, cement extravasation into the disc space was always found to occur through the fractured endplate or a vacuum cleft. Placing the needle tip far from the fractured endplate and using more solid cement appear to decrease the risk of leakage.