My wife is having a cement injected into her broken back bone (compression fracture). The surgeon’s assistant went over all the possible complications from infection to death. I asked her what the rate of the more serious complications is and she didn’t really know. Do you?

The procedure you mentioned (percutaneous vertebroplasty) is a common approach to the problem of vertebral compression fractures. But some of the newer research actually shows long-term results may not be any better than following a conservative treatment plan. The difference is in the immediate phase of healing — vertebroplasty does provide immediate pain relief for up to 80 per cent of the patients it is used on.

And there are the complications as you mentioned. Every effort is made to protect the patient and prevent any problems from occurring. But the fact is, complications do develop. Overall, the complication rate of percutaneous vertebroplasty is reported as 1.6 to 3.8 per cent. That is fairly low and based on meta-analyses (combining the results of many smaller studies together to see the overall complication rate).

Very severe complications like paralysis or even death are rare. One complication that may be more common is the leakage of the cement used into other areas. Studies report cement leakage in anywhere from five per cent of cases up to 87 per cent.

Leakage into the disc can cause the disc to harden and bulge thus putting pressure on the spinal cord or spinal nerve roots. Injection into the thoracic vertebra close to the heart could result in perforation of the heart itself.

Research efforts are underway to prevent cement leakage. One approach has been to look for individual patient risk factors or other variables that could be modified. If patients could be screened before surgery and identified as high risk for cement leakage, then perhaps the surgeon could do something different to change that. Or maybe patients at high risk just aren’t good candidates for this particular procedure.

A recent study from The Netherlands reported three major risk factors for cement leakage when using percutaneous vertebroplasty for osteoporotic vertebral compression fractures. First, leakage was more likely in the severe fractures. The presence of disc (cortical) disruption was another important risk factor. The surgeon doesn’t have control over either of those variables.

But the third risk factor is one surgeons can change and that is how viscous (thin or thick) the cement is. Low viscosity cements flow easily (they are less resistant to flow) so they fill in all the cracks in a bone fracture. This effect is good but the low viscosity also allows the fluid to seep into other areas. A higher viscosity cement clumps more and doesn’t spread as much so there is less leakage.

With the evidence available from this and other studies, it looks like the problem of cement leakage can be better managed. The surgeon can control the cement viscosity by selecting the cement with the best viscosity for the problem before injecting it into the bone.

three major risk factors for cement leakage when using percutaneous vertebroplasty for osteoporotic vertebral compression fractures. First, leakage was more likely in the severe fractures. The presence of disc (cortical) disruption was another important risk factor. The surgeon doesn’t have control over either of those variables.

But the third risk factor is one surgeons can change and that is how viscous (thin or thick) the cement is. Low viscosity cements flow easily (they are less resistant to flow) so they fill in all the cracks in a bone fracture. This effect is good but the low viscosity also allows the fluid to seep into other areas. A higher viscosity cement clumps more and doesn’t spread as much so there is less leakage.

The findings of this study highlight what surgeons have observed clinically about percutaneous vertebroplasty. Cement leakage occurs most often with severe vertebral compression fractures and when the disc has been compromised. With the evidence available from this and other studies, it looks like the problem of cement leakage can be better managed. The surgeon can control the cement viscosity by selecting the cement with the best viscosity for the problem before injecting it into the bone.