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Anne Asher

Kyphoplasty Complication - Cement Leakage

By February 24, 2013

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According to the American Journal of Roentgenology, the use of of kyphoplasty as a treatment for compression fractures of vertebrae is on the rise.

Related: Do Vertebroplasty and Kyphoplasty Relieve Pain?

Kyphoplasty is a minimally invasive spinal procedure done in an outpatient facility. When you have a kyphoplasty, you generally go home the same day of your surgery. The procedure is done with the doctor making a small incision in your spine, so that she can insert a deflated balloon inside your vertebral body. Once it's in place, the balloon is inflated, which makes space for bone cement to be injected. Then balloon is removed, and cement material is slowly injected to provide stability and relieve pain.

Although kyphoplasty is a popular procedure among doctors, and one that's quite easy on the patient, it's still considered "controversial". In August of 2009, the New England Journal published the results from 2 small randomized controlled trials, which found that patients receiving an injection of cement and those receiving a placebo injection experienced equal pain relief.

Another reason for raised eyebrows, in my opinion, may be related to medical complication called "cement leakage", which occurs when the injected cement escapes the spinal bone and makes it to your intervertebral disc.

A study from Phillips University in Germany looked at the complications 372 kyphoplasty patients experienced between the years of 2002 and 2011. Researchers identified a number of problems that resulted from this procedure - ranging from low blood pressure and fast heart beat related to the inflation of the balloons, to pain after the procedure, urinary tract infections, and more.

In the study, the leaking of cement outside the vertebra was by far and away the most common problem encountered. The researchers report that 129 patients, or 40.06% of the study participants, experienced cement leakage.

Cement leakage can result in new incidences of pain and can increase your risk for another vertebral fracture - in a neighboring bone. A smaller study, from the University of Rochester, compared vertebroplasties (vertebroplasty is a procedure similar to kyphoplasty), in 38 patients. One group received cement injection while the comparison group did not. The study found that of those who did receive cement, 58% experienced a fracture of a nearby vertebra; of those who were not injected, only 12% experienced an adjacent fracture.

Related: Spinal Surgery: Risk of Infection

Sources:

Bergmann M, Oberkircher L, Bliemel C, Frangen TM, Ruchholtz S, Krüger A.Early clinical outcome and complications related to balloon kyphoplasty.  Orthop Rev (Pavia). 2012 May 9;4(2):e25. doi: 10.4081/or.2012.e25. Epub 2012 Jun 21.

Lin EP, Ekholm S, Hiwatashi A, Westesson PL.Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.  AJNR Am J Neuroradiol. 2004 Feb;25(2):175-80.

Long, Suzanne, S. et. al. Vertebroplasty and Kyphoplasty in the United States: Provider Distribution and Guidance Method, 2001-2010. AJR December 2012 vol. 199 no. 6 1358-1364 doi: 10.2214/AJR.12.8733. http://www.ajronline.org/content/199/6/1358.abstract

Comments
February 24, 2013 at 12:27 pm
(1) Bob says:

I’m sorry but your interpretation of how the procedure is done is completely wrong. Cement is injected into an empty cavity that the balloon has created after it is removed. Also height restoration although nice to have is not the reason this procedure is done. It is to relieve pain in acute fractures. This procedure is rarely done on a burst fracture due to the added complications of retropulsion of bone materials and cement leakage. Cement leakage is not why this procedure is controversial it is because several articles (specifically two in NEJM) found that this procedure does not yield better pain relief than the non invasive alternatives.I don’t know where you got these facts from but please update accordingly.

February 24, 2013 at 6:43 pm
(2) backandneck says:

Updated and sent to our medical review board.

February 24, 2013 at 8:58 pm
(3) JuneWeb says:

Those 2 small randomized controlled trials published in New England Journal were done to compare the results of vertebroplasty and placebo injection. There was NO kyphoplasty in these studies. It shouldn’t be referenced when describing the efficacy of Kyphoplasty.

This article is extremely weak and can not be a reference. Please update accordingly.

February 25, 2013 at 1:24 pm
(4) Whitney says:

With all due respect, you may want to get your facts straight before posting an article like this one. The NEJM article was about vertebroplasty NOT kyphoplasty. The two are completely different procedures. Kyphoplasty is proven to be a lot safer and uses a thicker cement which is not prone to leakage like vertebroplasty…making this article completey invalid.

March 13, 2014 at 12:52 pm
(5) Renee Grace says:

Well can anyone here tell me what has happened to me? I had Kyphoplasty done on my T9, since the surgery, my pain has only increased not decreased, also soon after the surgery my back started breaking out, not pimples mind you, sores that ooze clear liquid, at first it started just in the area where the kyphoplasty had been done, but it has spread to my head and my bottom, it feels like millions of needled coming out of them. He sent me to a dermatologist that presribed cream that has done nothing, neosporin nothing, cream from the hospital nothing. This rash has been going on since my surgery Dec 2011! He released me only after he said nothing he has done could have made me worse! But I am allergic so many things, foods and medications. The thing is, its all in line with my spine no where else, its not all over my back just from where i had the surgey up, and on my head, and now getting them on my bottom. I am so scared of getting sepsis from it, I told my doc, and i was crying about the fact that I am scarred for life, i can never show my back again in public, its horrible, for someone who didnt have one scar before this on her back. All the while thinking he generally cared about his patients, but then he laughed and said oh you will be fine just dont let anyone see your back! He laughed at me, I was in tears, and in pain, he just laughed and got up and walked out..Who does that? Can you tell me if my surgery has caused this….

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