Intradiscal cement leak following percutaneous vertebroplasty

Study Design. A retrospective study to detect patients with cement leakage into the disc space following vertebroplasty. Objective. To determine the frequency, causes, and clinical significance of cement leakage into the disc space. Summary of Background Data. Much has been written about cement leakage into the epidural space following vertebroplasty but only little about intradiscal leakage. Methods. A total of 66 patients with 1 cemented osteoporotic, fractured vertebra between T5 and L5 were followed for at least 2 years. Two of the senior authors (Y.M. and A.P.) evaluated independently cement leakage into the disc space, possible causes were investigated, and the clinical results were evaluated according to patient self-assessment. Results. Detected in 27 patients, cement leakage into the disc space did not negatively affect patient satisfaction with the procedure. In 7 of these patients, leakage occurred through an intravertebral vacuum cleft and, in 8, through a perforation of the endplate created by the needle tip. In only 2 patients was cement found to cross the height of the vertebral body and leak into the contralateral disc. Conclusions. Apart from iatrogenic endplate perforation, cement extravasation into the disc space was always found to occur through the fractured endplate or a vacuum cleft. Placing the needle tip far from the fractured endplate and using more solid cement appear to decrease the risk of leakage.