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.


  • 1

    Abdul-Jalil YBartels JAlberti OBecker R: Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty. Spine 32:E589E5932007

  • 2

    Alfonso Olmos MSilva González ADuart Clemente JVillas Tomé C: Infected vertebroplasty due to uncommon bacteria solved surgically: a rare and threatening life complication of a common procedure. Spine 31:E770E7732006

  • 3

    Amoretti NHovorka IMarcy PYGrimaud ABrunner PBruneton JN: Aortic embolism of cement: a rare complication of lumbar percutaneous vertebroplasty. Skeletal Radiol 36:6856872007

  • 4

    Barr JDBarr MSLemley TJMcCann RM: Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:9239282000

  • 5

    Baumann ATauss JBaumann GTomka MHessinger MTiesenhausen K: Cement embolization into the vena cava and pulmonal arteries after vertebroplasty: interdisciplinary management. Eur J Vasc Endovasc Surg 31:5585612006

  • 6

    Biafora SJMardjetko SMButler JPMcCarthy PLGleason TF: Arterial injury following percutaneous vertebral augmentation: a case report. Spine 31:E84E872006

  • 7

    Burton AWMendel E: Vertebroplasty and kyphoplasty. Pain Physician 6:3353412003

  • 8

    Chen YJTan TSChen WHChen CCLee TS: Intradural cement leakage: a devastatingly rare complication of vertebroplasty. Spine 31:E379E3822006

  • 9

    Chiras JSola-Martinez MTWeill ARose MCognard CMartin-Duverneuil N: Percutaneous vertebroplasty. Rev Med Interne 16:8548591995

  • 10

    Cosar MSasani MOktenoglu TOzer AF: Spinal subdural hematoma as a rare complication of vertebroplasty: report of two cases. World Spine J 2:37402006

  • 11

    Cotten ADewatre FCortet BAssaker RLeblond DDuquesnoy B: Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and leakage of methyl methacrylate at clinical follow-up. Radiology 200:5255301996

  • 12

    Francois KTaeymans YPoffyn BVan Nooten G: Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report. Spine 28:E424E4252003

  • 13

    Freitag MGottschalk ASchuster MWenk WWiesner LStandl TG: Pulmonary embolism caused by polymethylmethacrylate during percutaneous vertebroplasty in orthopedic surgery. Acta Anaesthesiol Scand 50:2482512006

  • 14

    Galibert PDeramond HRosat PLe Gars D: Preliminary note on the treatment of vertebral angioma by percutaneous cement vertebroplasty. Neurochirurgie 33:1661681987

  • 15

    Jang JSLee SHJung SK: Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty: a report of three cases. Spine 27:E416E4182002

  • 16

    Jensen MEEvans AJMathis JMKallmes DFCloft HJDion JE: Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18:189719041997

  • 17

    Kose KCCebesoy OAkan BAltinel LDincer DYazar T: Functional results of vertebral augmentation techniques in pathological vertebral fractures of myelomatous patients. J Natl Med Assoc 98:165416582006

  • 18

    Lieberman IReinhardt MK: Vertebroplasty and kyphoplasty for osteolytic vertebral collapse. Clin Orthop Relat Res 415:SupplS176S1862003

  • 19

    Lim KJYoon SZJeon YSBahk JHKim CSLee JH: An intraatrial thrombus and pulmonary thromboembolism as a late complication of percutaneous vertebroplasty. Anesth Analg 104:9249262007

  • 20

    Moreland DBLandi MKGrand W: Vertebroplasty: techniques to avoid complications. Spine J 1:66712001

  • 21

    Müller MBiedermann MStrecker W: A complication during kyphoplasty. Cement penetration through the azygos vein into the superior vena cava. Orthopade 35:118311862006

  • 22

    Nussbaum DAGailloud PMurphy K: A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 15:118511922004

  • 23

    Peh WCGilula LA: Percutaneous vertebroplasty: indications, contraindications, and technique. Br J Radiol 76:69752003

  • 24

    Peh WCGilula LAPeck DD: Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 223:1211262002

  • 25

    Phillips FMTodd Wetzel FLiebermann ICampbell-Hupp M: An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27:217321792002

  • 26

    Sasani MOzer AFKaner TErcelen O: Spontaneous L2 vertebrae split fracture as an exceptional and late complication of kyphoplasty: a case report and literature review. Pain Pract 9:1411442008

  • 27

    Temiz CUmur ASBağdatoğlu CIslak SPabuscu YSelcuki M: Computerized tomography (CT) guided kyphoplasty. World Spine J 1:1861912006

  • 28

    Vats HSMcKiernan FE: Infected vertebroplasty: case report and review of literature. Spine 31:E859E8622006

  • 29

    Weber CHKrötz MHoffmann RTEuler EHeining SPfeifer KJ: [CT-guided vertebroplasty and kyphoplasty: comparing technical success rate and complications in 101 cases.]. Rofo 178:6106172006. (Ger)

  • 30

    Zheng ZM: The disaster complication of percutaneous vertebroplasty and kyphoplasty: cement leakage and its prevention. Zhonghua Yi Xue Za Zhi 86:302730302006


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