Incidence of and Risk Factors for Neurological Deficits Associated With Percutaneous Vertebral Augmentation

Study DesignRetrospective cohort study.ObjectivesTo investigate the incidence of neurological deficits associated with percutaneous vertebral augmentation (PVA) surgery and to identify related risk factors.MethodsWe performed a retrospective analysis of the clinical data of patients who underwent PVA surgery at our institution between 2017 and 2022. A range of clinical parameters, including age, sex, fracture cause, fracture segment, number of vertebrae treated, surgical approach and surgical method, were collected.ResultsThis study included a total of 1847 patients, including 422 (22.8%) men and 1425 (77.2%) women, with a total of 2319 diseased vertebrae. The mean age of the patients was 70.71 ± 8.80 years, with 211 (11.4%) patients aged under 60 years and 1636 (88.6%) patients aged over 60 years. Forty-six (2.5%) patients, accounting for 67 diseased vertebrae, were treated for tumors, whereas the remaining 1801 (97.5%) patients underwent surgery for fractures. Four hundred seventy-eight (20.6%) vertebrae underwent unilateral puncture, and the remaining 1841 (79.4%) vertebrae underwent bilateral puncture. Percutaneous vertebroplasty was performed on 1781 (76.8%) vertebrae, whereas percutaneous kyphoplasty was chosen for the remaining 538 (23.2%) vertebrae. Postoperative X-ray evaluations were conducted on the treated vertebrae, revealing that 403 (17.4%) vertebrae experienced polymethylmethacrylate (PMMA) leakage. Among the 1847 patients, 6 (7 diseased vertebrae) experienced nerve injuries postoperatively, and the incidence of neurological deficits after PVA surgery was 0.32%. Four of the 6 patients had nerve injuries due to PMMA leakage, and the other 2 patients had failed punctures. There was no statistically significant difference in terms of neurological complication rates according to patient age, sex, fracture segment, number of vertebrae treated, surgical approach or surgical method. However, the incidence of neurological complications was greater for patients with neoplastic fractures who underwent PVA surgery than for those with osteoporotic fractures.ConclusionsPVA is an effective minimally invasive procedure for treating osteoporotic and neoplastic vertebral fractures. However, PVA can lead to serious neurological deficits. The incidence of neurological deficits associated with PVA surgery is 0.32%. Compared with patients with osteoporotic fractures, patients with neoplastic vertebral fractures who undergo PVA have a greater risk of neurological complications.