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Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the
Alexis D Kelekis1, Jean-Baptiste Martin, Thierry Somon
1Department of Radiology and Neuroradiology, Geneva University Hospital, Geneva, Switzerland. Alexis.Kelekis@hcuge.ch
Study Design:
During vertebroplasty (VP), polymethylmethacrylate (PMMA) may leak into the posterior epidural venus plexus, provoking symptoms ranging from radicular pain to medullar compression.
Objectives:
To propose and test the feasibility of a procedure (cooling system) to prevent radicular irritation caused by foraminal PMMA leakage.
Summary Of Background Data:
Foraminal leak of PMMA, as observed during VP, may lead to radiculalgia. Several mechanisms of nerve root irritation have been proposed. Considering heat or local chemical irritation has led us to treat immediately by local periradicular irrigation with a cooling liquid.
Methods:
Four consecutive patients with observed foraminal leakage were treated by local fluid injection. Immediately after observation of a foraminal leak, a 20-gauge Chiba needle was positioned to reach the foramen. Ten cubic centimeters of lidocaine (0.2%) was followed by 100-200 cc of pressurized saline perfusion within 10-20 minutes (cooling system).
Results:
In all patients with foraminal leakage, no radicular pain existed after application of the cooling system. No complications were observed with its use.
Conclusion:
In presence of a foraminal leakage, the immediate application of a cooling irrigation may protect the root from injury, which is explained by the hypothesis that the main mechanism of injury may be more related to heat or chemical irritation of the nerve than compression.
Insights
A novel cooling system effectively prevents radicular pain caused by polymethylmethacrylate (PMMA) leakage during vertebroplasty (VP). This procedure irrigates the area with saline, protecting nerve roots from heat or chemical irritation.
Area of Science:
- Interventional Radiology
- Neurosurgery
- Pain Management
Background:
- Vertebroplasty (VP) involves injecting polymethylmethacrylate (PMMA), which can leak and cause nerve root irritation.
- Foraminal PMMA leakage during VP is a known cause of radicular pain (radiculalgia).
- Potential mechanisms for nerve root injury include thermal or chemical irritation.
Observation:
- Foraminal leakage of PMMA was observed during VP procedures.
- Four patients experiencing foraminal leakage were treated with a novel cooling system.
- The system involved local periradicular irrigation with lidocaine and pressurized saline.
Findings:
- The cooling system successfully prevented radicular pain in all treated patients.
- No complications were reported following the application of the cooling system.
- The procedure demonstrated feasibility in managing foraminal PMMA leakage.
Implications:
- Immediate cooling irrigation may protect nerve roots from injury during VP.
- This technique offers a potential solution to mitigate radicular symptoms post-VP.
- Further research can explore the long-term efficacy and broader application of this cooling system.