Complications of Percutaneous Vertebroplasty and Their Prevention
Vertebroplasty consists in the percutaneous injection of polymethylmethacrylate (PMMA) into vertebral collapses (VC) in order to obtain pain relief and mechanical strengthening of the vertebral body. It was first proposed by Galibert et al. in the treatment of malignant and aggressive vertebral hemangiomas (1). It is also now extensively used in osteoporotic VC, especially in the United States. It is an efficient treatment that is not free of complications. The Food and Drug Administration (FDA) has recently issued an alert about possible complications following the use of PMMA to treat osteoporotic compression fracture. Reports to the FDA concerned soft-tissue damage and nerve root compression related to the leakage of bone cement. In addition, the FDA mentioned the lack of prospective, randomized, controlled trials to characterize long-term safety and effectiveness of vertebroplasty and kyphoplasty. This paper will review the different types of cement extravasation, complications due to cement extravasation, local and general reactions not due to cement extravasation, and the prevention of other complications.