Cause of Cement Leakage After Vertebroplasty

Vertebroplasty is an accepted form of treatment for fractures of the vertebral body. A long thin needle is passed into the main part of the bone. A special X-ray called fluoroscopy helps the surgeon guide the needle to the correct spot. Bone cement is injected into the fractured vertebra. Sometimes the cement leaks out of the bone.

In this study the cause of cement leakage into the disc space is investigated. Out of 66 patients treated with vertebroplasty, 41 percent had cement leakage into the disc space. Most cases of cement leakage were caused by a fractured endplate. The vertebral endplate is the fibrocartilage cap on either side of the intervertebral disc.

Cement usually leaks into the epidural space around the spinal cord. This is the first study to show that leakage into the disc space is not as rare as once thought but actually quite common. If the needle tip goes in too far it can break through the endplate.

The authors advise surgeons to avoid pushing the needle in close to the endplate. If the endplate is already fractured, fluoroscopy can be used to make sure the needle tip stays outside the disc. Using thicker cement can also reduce the risk of leakage.

Finally, patient satisfaction with vertebroplasty was not decreased by cement leakage into the disc space. The success rate did not seem affected by leakage.

Reference: 

Yigal Mirovsky, MD, et al. Intradiscal Cement Leak Following Percutaneous Vertebroplasty. In Spine. May 1, 2006. Vol. 31. No. 10. Pp. 1120-1124.

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