Search

BACKGROUND AND PURPOSE: Recurrent or residual back pain after vertebroplasty (VP) is common, and many patients with these symptoms are evaluated by MRI. The purpose of this report is to describe post-treatment MRI findings after successful VP. METHODS: We identified all patients who underwent VP at our institution and later presented with back pain and had a spine MRI. From these patients, we identified a cohort with uncomplicated procedures, in whom back pain at the site of the VP was not the dominant pain source at follow-up. Using the pre- and postoperative MRIs and the VP conventional radiographs, we assessed such features as interval height loss and changes in marrow edema in treated vertebrae. RESULTS: Thirty patients (51 treated vertebrae) met our clinical criteria for uncomplicated VP. Nine (18%) of 51 vertebrae lost additional height after the procedure. Neither patient demographics nor variables associated with the procedure itself, including volume of cement injected, correlated with additional height loss after VP. Moderate or severe marrow edema was demonstrated in 62% of vertebrae on preoperative MRI and in 33% of vertebrae on follow-up MRI. Twenty-one percent of vertebrae had new areas of marrow edema on follow-up. Twenty-two percent of vertebrae imaged >6 months after VP had moderate or severe edema. CONCLUSION: Progressive and persistent edema and interval height loss after successful VP are common and should not be interpreted as sufficient evidence of ongoing pathology at the treated vertebral level.

Summary: The deposition of a subcutaneous cement tract is a potential complication of percutaneous vertebroplasty. These tracts can be a source of pain and tenderness for the patient. We describe a case of symptomatic cement deposition within a needle tract in the subcutaneous tissues that required surgical removal, and we describe a technique to prevent this complication in a second patient, by using needle redirection to cut across the cement core.

BACKGROUND AND PURPOSE: Intravertebral clefts have long been considered as pathognomonic for avascular necrosis and as a rare cause of compression fracture. We have observed unsuspected clefts opacifying frequently during vertebroplasty. Our purpose in this study was to determine the incidence of these clefts in symptomatic osteoporotic compression fractures, assess the sensitivity of MR imaging and conventional radiography in the detection of these clefts, and determine whether there is any prognostic significance of these clefts in patients treated with vertebroplasty. METHODS: Retrospective chart reviews were conducted of 135 vertebroplasty procedures performed during a 2-year period. MR images and conventional radiographs were reviewed for the presence of clefts defined as fluid-filled cavities on MR images or gas-filled cavities on conventional radiographs. Digital radiographs obtained at the time of the procedure were inspected for the presence of opacified clefts. Imaging findings were correlated with subjective pain scores documented before the procedure and at 1 week, 1 month, 6 months, and 12 months after vertebroplasty. RESULTS: Two hundred thirty-six osteoporotic compression fractures were treated with polymethylmethacrylate in 125 patients. Thirty-one and eight-tenths percent of the fractures were noted to contain clefts at the time of vertebroplasty. Fluid-filled clefts were detected on preoperative MR images in only 52.8% of the fractures with opacified clefts at vertebroplasty. Gas-filled clefts were evident on preoperative conventional radiographs in only 11.4% of the fractures with opacified clefts at vertebroplasty. No significant difference was noted in numerical pain scores between the two populations at baseline or 1 week or 1 month after the procedure. Pain scores at 6 and 12 months after vertebroplasty showed a trend toward greater pain relief in patients with clefts, although the difference was not statistically significant. A sustained, statistically significant decrease in pain scores after treatment (P < .01) was noted in both groups. CONCLUSION: Intravertebral clefts are much more common than previously described and probably represent fracture nonunions. Imaging is not sensitive in detecting these clefts before vertebroplasty. We advocate complete filling of the cleft with cement during vertebroplasty to maximize stabilization of the fracture fragments. There is a trend toward greater pain relief being achieved 6 and 12 months after the procedure in patients with clefts that are opacified at the time of vertebroplasty.