Clin Orthop Surg.  2010 Dec;2(4):203-208. 10.4055/cios.2010.2.4.203.

Revision Surgery after Vertebroplasty or Kyphoplasty

• Ha KY
• Kim KW
• Kim YH
• Oh IS
• Park SW

• KMID: 1719319
• DOI: http://doi.org/10.4055/cios.2010.2.4.203

Abstract

BACKGROUND
We wanted to investigate the leading cause of failed vertebroplasty or kyphoplasty.
METHODS
Twelve patients (10 females and 2 males) who underwent revision surgery after vertebroplasty or kyphoplasty were included. In 4 cases, vertebroplasty was done for two or more levels. Six cases with kyphoplasty were included. Through the retrospective review of the radiographic studies and medical record, we analyzed the etiology of the revision surgery.
RESULTS
Uncontrolled back pain was the main clinical presentation. In 4 cases, neurological symptoms were noted, including one case with conus medullaris syndrome. The average time to the revision surgery after vertebroplasty or kyphoplasty was 15 months. Infection (4 cases) and progressive kyphosis with collapse (8 cases) were the causes for the revision. A solid pattern of inserted bone cement and bone resorption around the cement were noted in the all cases with progressive collapse and kyphosis.
CONCLUSIONS
Infection, misdiagnosis and progressive kyphosis were causes of the revision surgery after vertebroplasty and kyphoplasty. A solid pattern of accumulation of bone cement and peri-cement bone resorption might be related with the progressive collapse.

Keyword

Osteoporosis; Vertebral fracture; Vertebroplasty; Revision surgery

MeSH Terms

Adult
Aged
Bone Cements/therapeutic use
Disease Progression
Female
Fractures, Compression/etiology/*surgery
Humans
*Kyphoplasty/adverse effects
Male
Middle Aged
Osteoporosis/complications
Reoperation
Spinal Fractures/etiology/*surgery
Treatment Failure
*Vertebroplasty/adverse effects
Young Adult

Figure

• 

  Fig. 1 Case no. 3. Serial MRI (April 21 and 22, 2006 and 2 weeks later) of the kyphoplasty that was done for L1 under the misdiagnosis of osteoporotic compression fracture. Destructive changes of an adjacent endplate and bone resorption around the bone cement were noted.

• 

  Fig. 2 Case no. 9. (A) Vertebroplasty of T12: note the solid and trabecular types of bone cement patterns, the peri-cement bone resorption and the local kyphosis. (B) On the CT and MR images, compression of the conus medullaris by progressive kyphosis and retropulsed bone were noted. The solid-type bone cement pattern, peri-cement bone resorption and a high signal around the cement were also noted. (C) Anterior decompression and fusion were performed.

• 

  Fig. 3 Gross and microscopic findings of the peri-cement tissue taken by anterior resection. The piecemeal retrieval of cement was not found to be a complicated procedure; the cement had been encircled by fibrous tissues. Thick amorphous fibrous tissue without extensive necrosis or bone remodeling was found (H&E, × 40).

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