Percutaneous vertebroplasty for spinal metastases:: Complications

被引:183
作者
Barragán-Campos, HM
Vallée, JN
Lo, D
Cormier, E
Jean, B
Rose, M
Astagneau, P
Chiras, J
机构
[1] Univ Paris 06, Dept Diagnost & Intervent Neuroradiol, F-75651 Paris, France
[2] Univ Paris 06, Dept Anesthesiol, F-75651 Paris, France
[3] Univ Paris 06, Dept Publ Hlth, F-75651 Paris, France
[4] Univ Paris 06, Grp Hosp Pitie Salpetriere, Assistance Publ Hop Paris, F-75651 Paris, France
关键词
D O I
10.1148/radiol.2381040841
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To retrospectively evaluate complications of percutaneous vertebroplasty (PV) performed with polymethylmethacrylate cement to treat pain in patients with metastases to the spine. Materials and Methods: This study had institutional review board approval; patient informed consent for the review of records and images was not required. In 2 years, 117 patients ( 38 men [32.5%] and 79 women [67.5%]; mean age, 58.2 years) underwent 159 fluoroscopy-guided PV procedures to treat 304 vertebrae. Spinal metastases included osteolytic, osteoblastic, and mixed lesions. Complications were characterized as local or systemic. Evaluated data included immediate imaging findings (on radiographs and computed tomographic scans) and clinical findings at 30-day follow-up. chi(2) or Fisher exact testing was performed for univariate analysis of variables. Results: The primary cancers were breast cancers (45.3%), lung cancers (14.5%), myeloma (7.7%), or other cancers ( 32.5%). Among the 423 cement leakages identified, 332 (78.5%) were vascular and 91 (21.5%) were nonvascular. Vascular leaks were classified as venous epidural leaks, paravertebral and foraminal plexus leaks, and leaks to the vena cava, while nonvascular leaks included puncture trajectory leaks, paravertebral soft tissue leaks, and diskal leaks. Patients with nonvascular leaks were asymptomatic. Eight (6.8%) patients experienced complications, and seven of these complications were symptomatic. Among these eight patients, six (5.1%) had local complications (puncture site hematoma in two patients and radicular pain [successfully treated with nonsteroidal anti-inflammatory drugs or corticosteroids] in four patients), and two (1.7%) had systemic complications (pulmonary embolism resulting from cement migration through the vena cava). One of the latter patients died. Univariate analyses revealed a significant association between cement migration through the vena cava and pulmonary embolism (P = .001) but not between foraminal venous leakage and radicular pain (P = .123). Conclusion: Despite numerous technical incidents (leaks), PV-induced complications were rare, leading to the hypothesis that systemic complications are a consequence of intravascular leakage while local complications are a consequence of cement-related irritation, compression and/or ischemia, and/or needle-induced trauma. (c) RSNA, 2006.
引用
收藏
页码:354 / 362
页数:9
相关论文
共 29 条
  • [1] Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty
    Bernhard, J
    Heini, PF
    Villiger, PM
    [J]. ANNALS OF THE RHEUMATIC DISEASES, 2003, 62 (01) : 85 - 86
  • [2] BONTOUX D, 1997, CANC SECONDAIRE OS, P19
  • [3] Brado M, 1998, ORTHOPADE, V27, P269
  • [4] Castillo M, 2000, AM J NEURORADIOL, V21, P948
  • [5] Chiras J, 1995, ECHECS COMPLICATIONS, P149
  • [6] Cortet B, 1997, REV RHUM, V64, P177
  • [7] Percutaneous vertebroplasty for osteolytic metastases and myeloma: Effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up
    Cotten, A
    Dewatre, F
    Cortet, B
    Assaker, R
    Leblond, D
    Duquesnoy, B
    Chastanet, P
    Clarisse, J
    [J]. RADIOLOGY, 1996, 200 (02) : 525 - 530
  • [8] MRI IN THE DETECTION OF MALIGNANT INFILTRATION OF BONE-MARROW
    DAFFNER, RH
    LUPETIN, AR
    DASH, N
    DEEB, ZL
    SEFCZEK, RJ
    SCHAPIRO, RL
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 1986, 146 (02) : 353 - 358
  • [9] Percutaneous vertebroplasty with polymethylmethacrylate - Technique, indications, and results
    Deramond, H
    Depriester, C
    Galibert, P
    Le Gars, D
    [J]. RADIOLOGIC CLINICS OF NORTH AMERICA, 1998, 36 (03) : 533 - +
  • [10] Deramond H, 2002, PERCUTANEOUS VERTEBROPLASTY, P165