• Alpesh A Patel, Alexander R Vaccaro, Gregg G Martyak, James S Harrop, Todd J Albert, Steven C Ludwig, Jim A Youssef, Daniel E Gelb, Hallett H Mathews, Jens R Chapman, Edward H Chung, Gregory Grabowski, Timothy R Kuklo, Alan S Hilibrand, and D Greg Anderson.
• Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA. alpesh2@gmail.com
• Spine. 2007 Jul 15; 32 (16): 172817341728-34.

Study DesignA retrospective review.ObjectiveThe purpose of this study is to document a series of cases of neurologic deficit following percutaneous vertebral stabilization, to identify patterns of neurologic injury, and to describe potential methods for avoiding these injuries.Summary Of Background DataPercutaneous vertebral stabilization procedures, including vertebroplasty and kyphoplasty, have become a widely used for the treatment of osteoporotic vertebral compression fractures, primary and metastatic vertebral tumors, and traumatic burst fractures. Despite an increasing array of indications, there have been few reports of adverse events. Neurologic complications associated with vertebroplasty and kyphoplasty have been described previously as case reports and have generally been considered as infrequent and minor in severity.MethodsThe clinical course of 14 patients with documented loss of neurologic function following percutaneous vertebral cement augmentation was retrospectively reviewed.ResultsThe average patient age was 74.9 years (range, 46-88 years) with 3 male and 11 female patients. Four patients underwent a vertebroplasty procedure while 10 were treated with kyphoplasty. Six patients developed neurologic deficits acutely (<24 hours of procedure). The remaining 8 patients developed neurologic symptoms at an average of 37.1 days (range, 3-112 days) postprocedure. Neurologic deficits were recorded as ASIA A in 4 patients, ASIA B in 2 patients, ASIA C in 1 patient, and ASIA D in 7 patients. Twelve of 14 patients (85.7%) required revision open surgical intervention for treatment of their neurologic injury.ConclusionPercutaneous vertebroplasty and kyphoplasty have been reported to be safe options for the treatment of painful osteoporotic vertebral fractures. Although complications are infrequent, there remains the potential for catastrophic neurologic injury. Physicians performing these procedures need to be aware of these potential complications and be prepared to respond in an emergent manner (surgically) if a need arises.

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