Pierre-Marie Chiaroni1, Kévin Premat1,2, Eimad Shotar1, Mehdi Drir3, Hugo Trebern1, Adrien Beth1, Baptiste Bonnet1, Jugurtha Mathout3, Raphaël Bonaccorsi4, Laetitia Morardet5, Évelyne Cormier1, Jacques Chiras6, Frédéric Clarençon7,8,9. 1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 2. Sorbonne University, Paris, France. 3. Department of Anesthesiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 4. Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 5. Department of Oncology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. 6. Department of Radiology, Clinique Bizet, Paris, France. 7. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, 47 boulevard de l'Hôpital, 75013, Paris, France. frederic.clarencon@aphp.fr. 8. Sorbonne University, Paris, France. frederic.clarencon@aphp.fr. 9. GRC BioFast, Sorbonne University, Paris, France. frederic.clarencon@aphp.fr.
Abstract
OBJECTIVES: Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used. METHODS: This retrospective monocentre study included 104 patients who underwent reinforced cementoplasty and 3425 patients who underwent cementoplasty between 2012 and 2020. Operative reports and fluoroscopic images were reviewed to identify extraction attempts and their outcomes. RESULTS: Six patients (5.8%) had a malpositioned spindle, and all of them underwent spindle extraction during reinforced cementoplasty, with an 80% success rate. A total of 7 attempts were performed, using 2 different techniques. One thousand one hundred thirty patients (32%) had a cement leak in soft tissues, and 7 (0.6%) underwent cement leakage extraction during cementoplasty, with a 100% success rate. A total of 10 attempts were performed, using 3 different techniques. No major complication related to the extraction procedures occurred. CONCLUSIONS: Spindle malpositions and soft tissue cement leakages are not uncommon. We described 5 different percutaneous techniques that were safe and effective to extract spindles and paravertebral cement fragments. KEY POINTS: • Soft tissue cement leakages or spindle malpositions are a non-rare occurrence during cementoplasty, and may cause technical failure and/or chronic pain. • Most soft tissue cement fragments and malpositioned spindles can easily be extracted using simple percutaneous techniques.
OBJECTIVES: Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used. METHODS: This retrospective monocentre study included 104 patients who underwent reinforced cementoplasty and 3425 patients who underwent cementoplasty between 2012 and 2020. Operative reports and fluoroscopic images were reviewed to identify extraction attempts and their outcomes. RESULTS: Six patients (5.8%) had a malpositioned spindle, and all of them underwent spindle extraction during reinforced cementoplasty, with an 80% success rate. A total of 7 attempts were performed, using 2 different techniques. One thousand one hundred thirty patients (32%) had a cement leak in soft tissues, and 7 (0.6%) underwent cement leakage extraction during cementoplasty, with a 100% success rate. A total of 10 attempts were performed, using 3 different techniques. No major complication related to the extraction procedures occurred. CONCLUSIONS: Spindle malpositions and soft tissue cement leakages are not uncommon. We described 5 different percutaneous techniques that were safe and effective to extract spindles and paravertebral cement fragments. KEY POINTS: • Soft tissue cement leakages or spindle malpositions are a non-rare occurrence during cementoplasty, and may cause technical failure and/or chronic pain. • Most soft tissue cement fragments and malpositioned spindles can easily be extracted using simple percutaneous techniques.