The major complications of transpedicular vertebroplasty

A review

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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.

Abbreviations used in this paper: SDH = subdural hematoma; VB = vertebral body.

Article Information

Address correspondence to: Murat Cosar, M.D., PK: 89 17000 Canakkale, Turkey.

© AANS, except where prohibited by US copyright law.



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    Case 1. Axial (left) and (sagittal) CT scans showing cement leakage (arrows) into the subdural space.

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    Case 2. A: Sagittal T2-weighted MR image showing SDH (arrow) extending from T-1 to L-2. B: Sagittal T1-weighted MR image showing an SDH (arrow) extending from T-1 to L-2. C: Axial T2-weighted MR image showing arachnoiditis (arrow). D: Sagittal T2-weighted MR image showing arachnoiditis (arrow).

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    Case 3. A and B: Axial (A) and sagittal (B) T2-weighted MR images demonstrating SDH (arrows) at T-12. C: Axial T2-weighted MR image showing arachnoiditis (arrow) at L-2.

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    Case 4. A: Preoperative radiograph showing compression fractures of the L-1 and L-4 VBs. B and C: Axial (B) and sagittal (C) CT scans showing epidural leakage of bone cement (arrows) at L-4.

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    Case 5. Sagittal T2-weighted MR image (left) and axial CT scan (right) demonstrating epidural leakage of bone cement (arrows) at T-7.

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    Case 6. Lateral lumbar radiograph (left) and axial T2-weighted MR image (right) showing epidural leakage of bone cement (arrows) at L-3.

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    Case 7. A: Preoperative T2-weighted MR image showing the compression fractures at the L-2 VB. B: Plain radiograph with fluoroscopy obtained perioperatively demonstrates successful kyphoplasty. C: Lateral plain radiograph obtained at Week 4 postoperatively shows an L-2 vertebral burst fracture.



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