Despite being minimally invasive, these cement injection procedures are not without significant risks, so the decision to use these procedures is made on a case-by-case basis and should not be taken lightly.
- The most common complication is leakage of cement out of the vertebra with injection and before final hardening. The potential for this complication is why X-ray guidance is used to visualize the cement while it is being injected.
- If the cement leaks back into the spinal canal it can compress the spinal cord and nerves, causing new pain and neurological problems.
- There have also been rare case reports of pulmonary embolism of the lungs and even death associated with these procedures.
Part of the problem with bone cement is that when it is in the very viscous (thin, not thick) state, it can leak out into the veins around the spine, especially if it is inserted under high pressure. Once it gets into the veins it can embolize to the lungs and there have been case reports of severe morbidity (i.e. respiratory distress or death) associated with embolization.
Overall, however, these percutaneous vertebral body cement injection procedures represent a very useful treatment option for the care of vertebral fractures in select cases. With all of this in mind, the patient and doctor must sit down and discuss whether such a procedure is right for the patient.
The standard care for vertebral compression fractures is still through the use of pain medication, brace immobilization, progressive mobilization, and time. Compression fractures have a high rate of success in terms of healing although it may take a while (about three months). Generally, most clinicians will wait to see if the fracture will heal on its own.
For acute, mild to moderate, activity-related pain associated with a vertebral fracture, patients are usually advised to wait at least three months before making a decision on surgical intervention.
However, if the patient is in so much pain that he or she cannot function, or requires high dose narcotic pain medications with unacceptable side effects, vertebral augmentation surgery should be considered sooner. Also, acute severe wedging, or progressive vertebral collapse or wedging over serial X-rays, should prompt early consideration for cement augmentation.
Multiple Compression Fractures may require surgical attention
Finally, the rare case of late vertebral fracture non-union (failure for the fracture fragments to heal together), with continued disabling back pain, is an excellent indication for a cement augmentation procedure.