• Michael A Bohl, Rajiv Sethi, and Jean-Christophe Leveque.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA. Electronic address: Michael.Bohl@bnaneuro.net.
• World Neurosurg. 2020 Feb 1; 134: e928-e936.

ObjectiveTo measure the incidence and severity of cement extravasation in adult patients undergoing prophylactic vertebroplasty as part of a spinal reconstruction procedure.MethodsConsecutive adult patients treated with prophylactic vertebroplasty during a spinal reconstruction procedure were reviewed over a 46-month period. Patients without a postoperative computed tomography scan were excluded. Spine reconstruction was defined as any procedure involving ≥6 levels of fusion or a 3-column osteotomy. Cement extravasation was graded using a novel grading system. Fisher exact tests were performed to identify independent predictors of cement extravasation.ResultsInclusion and exclusion criteria were met by 34 patients comprising 112 vertebral bodies (VB). All 34 patients (100%) had computed tomography evidence of cement extravasation. Of 112 VBs, 103 (92.0%) demonstrated cement extravasation. Thirteen VBs (11.6%) in 9 patients (26.5%) had cement extending to the vena cava or end-organs or cement causing spinal canal stenosis (grade 4 and 5 extravasation). No permanent clinical sequelae were found in these 9 patients. Upper thoracic vertebrae (C7-T6) had significantly higher rates of grade 4 and 5 extravasation than lower thoracic-lumbar vertebrae (T7-L5) (P = 0.004).ConclusionsAlthough no patients in this study experienced known long-term consequences of prophylactic vertebroplasty, 26.5% of patients had cement extravasation that threatened end-organs or neural elements. These results prompted us to change our practice from cementing upper thoracic VBs to using hooks instead. Cement injection is associated with serious risks and should be performed selectively. Larger prospective studies are needed to verify these results.Copyright © 2019 Elsevier Inc. All rights reserved.

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