Lumbar Vertebroplasty Risks
Lumbar vertebroplasty carries major complication rates of less than 1% for osteoporotic fractures and less than 5% for cancer-related fractures, with cement leakage being the most common technical complication (occurring in up to 72% of cases on CT imaging, though most remain asymptomatic). 1
Mortality and Catastrophic Complications
The most serious risks include:
- Death: 0.5% mortality rate, attributed to cement pulmonary embolus, chest infections following general anesthesia, or sepsis after emergency spinal decompression 1
- Paralysis or spinal cord injury: Requiring emergency decompression for hematoma or neuropathy (occurred in 13 patients across 987 patients in systematic review = ~1.3%) 1
- Symptomatic pulmonary emboli: 4 cases in the same systematic review (~0.4%) 1
- Cardiovascular collapse: From free methylmethacrylate monomer or anaphylaxis to cement 1
Common Technical Complications
Cement Leakage
This is the most frequent complication but usually asymptomatic:
- Incidence: 27-72% when detected by CT imaging 1
- Asymptomatic cement pulmonary emboli: 26% on follow-up CT, with no reactive pulmonary changes 1
- Locations: Most commonly discal or into segmental veins; spinal canal leakage is rare 1
- Clinical significance: The vast majority remain asymptomatic, but cement leakage is a significant risk factor for new vertebral fractures (aOR = 3.43,95% CI: 2.17-5.41) 2
Moderate Complications (2% Rate)
- Deep infection (osteomyelitis, epidural abscess)
- Hemothorax
- Vascular injury or paraspinal hematoma
- Fracture of rib, pedicle, or vertebral body
- Pneumothorax (for thoracic levels)
- Bowel/bladder dysfunction 1
New Vertebral Fractures
Secondary fractures occur at similar rates whether treated with vertebroplasty or conservative management (18.8% conservative vs 19.4% vertebroplasty over 2 weeks to 2 years; standardized mean effect 0.064,95% CI −0.57 to 0.70, not significant) 1
However, specific risk factors for new fractures after vertebroplasty include:
- Older age (aOR = 1.08 per year; OR = 1.519) 2, 3
- Female sex (aOR = 2.11,95% CI: 1.60-2.79) 2
- Multiple treated vertebrae (aOR = 2.27,95% CI: 1.18-4.35) 2
- Cement leakage (aOR = 3.43,95% CI: 2.17-5.41) 2
- Lower bone mineral density (OR = 0.108) 3, 4
- Diabetes (OR = 3.273) 3
- Compact cement distribution pattern 4
Postoperative Residual Pain
Low back pain persists in approximately 23% of patients after PVP 5. Risk factors include:
- Age >75 years
- ≥2 fractured vertebrae
- Lumbar spine comorbidities
- Preoperative fascial injury/edema
- Site of fracture
- Poor emotional status 6, 5
Quality Benchmarks
Acceptable complication thresholds that should trigger practice review if exceeded:
Critical Caveats
The systematic review data shows wide variability in serious complication rates (0-11.5%) and mortality (0-7%) across studies, reflecting differences in patient selection, fracture morphology, use of general anesthesia, and cement volume injected 1. Studies that excluded posterior wall involvement or epidural extension had lower complication rates, emphasizing the importance of careful patient selection 1.
Patients must be counseled that while major complications are uncommon, the potential for paralysis, pulmonary embolism, infection, and death exists, and cement leakage—though usually asymptomatic—is very common 1.