[Experiences with cement leakage after balloon kyphoplasty]

Kyphoplasty is associated with a low incidence of cement leakage and this usually tends to be clinically asymptomatic. However, there is a potential for life-threatening complications from extraspinal leakage resulting in vascular, cardiac and pulmonary embolisms. A total of eight cases of open surgical thrombectomy for cardiopulmonary cement leakage have been published in the current literature to date. Besides the description of a consecutive series with special reference to extraspinal cement leakage this article presents the results after successful endovascular removal of intravenous cement fragments following kyphoplasty in two patients.

In 46 cases following balloon kyphoplasty the number and amount of extraspinal venous cement leakage was retrospectively determined using computed tomography (CT). The number of cement embolisms into the pulmonary venous system was differently revealed for patients showing no extravertebral leakage or leakage only into the external vertebral venous plexus compared to leakage into the major venous vessels, azygos and hemiazygos vein or inferior vena cava.

In 8 out of 046 cases (17.4 %) leakage into the external vertebral venous plexus was detected. In 5 out of 8 cases without involvement of the azygos/hemiazygos vein or inferior vena cava no pulmonary cement embolism was detected. In 3 out of 8 cases the inferior vena cava or azygos/hemiazygos vein was reached and additionally asymptomatic peripheral pulmonary cement embolism was induced in these cases. In two cases harboring residual intravasal cement fragments treatment was successful using endovascular extraction techniques.

A computed tomography scan after kyphoplasty is recommended for all cases. If there is involvement of the inferior vena cava or the azygos/hemiazygos vein an additional CT scan of the chest should follow, even in asymptomatic cases. Residual intravasal cement fragments are safely extractable using endovascular techniques.