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Acta Radiol. 2012 Jun 1;53(5):569-72. doi: 10.1258/ar.2012.120222. Epub 2012 May 27.

Prevalence of extravertebral cement leakage after vertebroplasty: procedural documentation versus CT detection.

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1
College of Medicine, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

Reported incidence of extravertebral cement leakage after vertebroplasty varies widely across studies.

PURPOSE:

To retrospectively compare the relative detection rates of extravertebral leakage noted under intra-procedural fluoroscopic surveillance, postprocedure plain radiographs, and postprocedure computed tomography (CT) in a cohort of patients undergoing vertebroplasty.

MATERIAL AND METHODS:

With IRB approval, we retrospectively identified 181 patients with 277 levels treated with percutaneous vertebroplasty among a total of 1255 patients undergoing vertebroplasty between 1999 and 2010 who had subsequently undergone a CT examination that included the treated level(s). Categories of leakage were paravertebral, end plate, epidural, and prevertebral venous leakage. CT-detected leak rates were then compared to those noted on the vertebroplasty procedure reports and the archived fluoroscopic images for this same cohort using Pearson's χ(2) test.

RESULTS:

One hundred and forty-nine (82%, 95% CI 76-87%) of 181 patients demonstrated evidence of some type of leakage on CT at one or more treated levels. Sixty-two (34%, 95% CI 28-42%) and seventy-seven (50%, 95% CI 43-57%) of 149 CT-detected leaks were reported in the procedural dictation or detected on plain radiography (P = 0.01 and 0.006, respectively). The most common type of leakage noted on CT was end plate (n = 81, 45%, 95% CI 38-52%), followed by paravertebral (n = 64, 35%, 95% CI 29-43%), epidural (n = 36, 20%, 95% CI 15-26%), and prevertebral venous (n = 32, 18%, 95% CI 13-24%).

CONCLUSION:

Cement leakage after vertebroplasty is common and is often not reported by operators in procedural dictations. CT detects substantially more leaks than plain radiography.

PMID:
22637642
DOI:
10.1258/ar.2012.120222
[Indexed for MEDLINE]

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