Intra-Operative Complic atio n of Lumbar Kyphoplasty Instrumentatio n in Non-Osteoporotic Patients with Compression Fractures

Abstract

Background: Vertebral augmentation is a surgical procedure used to stabilize fractured vertebrae and reduce pain in patients with compression fractures. When intra-operative and post-operative complications do occur, they can have dire consequences. Some of the common risks associated with kyphoplasty are worsening of the fracture, infections, spinal cord compression, etc. Typically, we do not consider the risk of instrumentation failure. Objectives: In 2 cases, we describe patients who has undergone kyphoplasties with live fluoroscopic guidance. Both procedures used a unipedicular approach and the CareFusion system (Becton Dickinson, Franklin Lakes, NJ). The CareFusion AVAFlex curved augmentation needle was used, and intra-operatively the handle broke off at the neck making it difficult to remove the cannula and curved needle. To remove the system, an Arthrex Reamer (Arthrex Inc., Naples, NY).was used with Chuck Key (Arthrex Inc., Naples, NY). Study Design: Case report. Setting: Outpatient Interventional Pain Clinic. Methods: The vertebral body was accessed with an AVAFlex curved needle, a CareFusion AVAMax vertebral balloon, and Cement injection with polymethylmethacrylate, were used. The removal of the AVAFlex cannula was attempted with a gripping and pulling motion of the blue handle on the cannula, which resulted in the handle breaking at the most distal portion of the cannula. The cannula was then removed using the Arthrex Reamer with Chuck Key. The entire cannula was successfully removed from the vertebral body after cement had been delivered. Results: The density of bone tissue in a traumatic compression fracture of a nonosteoporotic individual will be higher and less porous when placing the needle and cannulas. Also, it is important to have an understanding of the different instruments that are available in the operative setting. Limitations: Small sample size. Conclusion: Instrumentation experience, understanding how to handle instrument failures, bone health of the patient, and the history of mechanism for compression fracture should all be considered when performing kyphoplasty. Key words: Kyphoplasty, vertebroplasty, compression fracture, instrumentation failure