Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the "cooling system".

Abstract:

STUDY DESIGN:During vertebroplasty (VP), polymethylmethacrylate (PMMA) may leak into the posterior epidural venus plexus, provoking symptoms ranging from radicular pain to medullar compression. OBJECTIVES:To propose and test the feasibility of a procedure (cooling system) to prevent radicular irritation caused by foraminal PMMA leakage. SUMMARY OF BACKGROUND DATA:Foraminal leak of PMMA, as observed during VP, may lead to radiculalgia. Several mechanisms of nerve root irritation have been proposed. Considering heat or local chemical irritation has led us to treat immediately by local periradicular irrigation with a cooling liquid. METHODS:Four consecutive patients with observed foraminal leakage were treated by local fluid injection. Immediately after observation of a foraminal leak, a 20-gauge Chiba needle was positioned to reach the foramen. Ten cubic centimeters of lidocaine (0.2%) was followed by 100-200 cc of pressurized saline perfusion within 10-20 minutes (cooling system). RESULTS:In all patients with foraminal leakage, no radicular pain existed after application of the cooling system. No complications were observed with its use. CONCLUSION:In presence of a foraminal leakage, the immediate application of a cooling irrigation may protect the root from injury, which is explained by the hypothesis that the main mechanism of injury may be more related to heat or chemical irritation of the nerve than compression.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Kelekis AD,Martin JB,Somon T,Wetzel SG,Dietrich PY,Ruefenacht DA

doi

10.1097/00007632-200307150-00027

keywords:

subject

Has Abstract

pub_date

2003-07-15 00:00:00

pages

E265-9

issue

14

eissn

0362-2436

issn

1528-1159

pii

00007632-200307150-00027

journal_volume

28

pub_type

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