the Risks and Complications of Bone Cement Surgery

What are the complications of bone cement?

Dear Doctor, my grandmother recently underwent a vertebroplasty procedure.
Here is a detailed account of the events: On January 14, 2005, an X-ray was taken during an outpatient visit, and the doctor indicated that the ninth vertebra was hollow.
The doctor suggested that injecting bone cement during surgery could alleviate the patient's discomfort, stating that the procedure was simple and that she could be discharged in 3-4 days.
However, neither the patient nor the family was informed about any potential risks or error rates associated with the surgery.

On January 17, 2005, she was admitted to the hospital for routine examinations, including an X-ray.
On January 18, 2005, from 8:30 to 11:30, the surgery was performed, and she returned to her room by 12:30.
Throughout this process, neither the physician nor the nursing staff provided any information regarding post-operative observations or precautions.
The physician did not fulfill their duty to monitor the patient after the surgery for any changes or abnormalities.

On January 19, 2005, an X-ray was taken at 8 AM post-surgery.
At 6:30 PM, she attempted to get out of bed to use the restroom.
Although she could stand, she was unable to walk.
A nurse was present and offered a wheelchair, so she was transported to the restroom in the wheelchair.
The nursing staff did not promptly recognize the patient's abnormal condition (the physician was making rounds at that time and had instructed the nurse to call him if needed, but he did not return to check on her condition).

On January 20, 2005, she again attempted to get out of bed to use the restroom but remained unable to walk and was transported by wheelchair.
At 4:20 PM, the doctor finally came to check on her and discovered that the patient had lower limb numbness and was unable to move her legs.
An urgent CT scan and MRI were performed, revealing that the bone cement was compressing the nerves.
A second surgery was conducted that evening at 7 PM.
I have two questions:
1.
With today's medical technology and equipment, why was it not possible to determine whether there were any fractures in the vertebrae prior to surgery, and why were there no monitoring measures in place during the procedure to detect signs of cement leakage, which led to nerve compression and resulted in this unfortunate outcome?
2.
Why was only an X-ray performed, which failed to identify the excess bone cement compressing the nerves? If a CT scan or MRI had been conducted at that time, would it have allowed for earlier detection of the nerve compression and potentially prevented the severe consequences we are facing today? Additionally, how should we proceed to seek compensation from the relevant authorities, and what steps can we take to address the current issue of lower limb paralysis?

Mr. Chen, 10~19 year old female. Ask Date: 2005/01/31

Dr. Yang Zhengfan reply Orthopedics

Dear Mr.
Chen,
Regarding your question, I have thought about it for a long time and I am not sure how to respond.

1.
The risk of cement leakage during vertebroplasty is not low, with foreign statistics indicating a range of approximately 2-10%.
Most cases of leakage do not present with neurological symptoms, but unfortunately, your grandmother is one of the few exceptions.
2.
Postoperative X-rays are almost universally accepted as the standard practice.
Unless there is a strong suspicion of nerve compression, a CT scan is typically not performed.
3.
During the surgery, a mobile X-ray machine is usually used to monitor for any leakage.
I hope you can discuss this further with the surgeon and avoid pursuing legal action.
The purpose of the surgery is to alleviate the patient's suffering, and if the outcome is not satisfactory, seeking compensation may undermine the surgeon's efforts.

Reply Date: 2005/01/31

More Info

Bone cement surgery, often referred to as vertebroplasty or kyphoplasty, is a minimally invasive procedure used to treat vertebral compression fractures, typically caused by osteoporosis. While this procedure can provide significant pain relief and improve mobility, it is not without its risks and potential complications. Understanding these aspects is crucial for patients and their families, especially in light of the unfortunate experience your grandmother faced.

Risks and Complications of Bone Cement Surgery
1. Cement Leakage: One of the most significant risks associated with bone cement surgery is the leakage of the cement into surrounding tissues, including the spinal canal. This can lead to nerve compression, resulting in symptoms such as numbness, weakness, or paralysis in the lower extremities. In your grandmother's case, it appears that the cement may have leaked and compressed a nerve, necessitating a second surgery.

2. Infection: As with any surgical procedure, there is a risk of infection. Although the risk is relatively low, it can lead to severe complications if not addressed promptly.

3. Fracture of Adjacent Vertebrae: After a vertebroplasty or kyphoplasty, there is a possibility that adjacent vertebrae may become weakened and subsequently fracture. This is due to the altered biomechanics of the spine after the procedure.

4. Allergic Reactions: Some patients may experience allergic reactions to the materials used in the procedure, including the bone cement itself.

5. Persistent Pain: While many patients experience relief from pain, some may continue to have pain after the procedure, which could be due to other underlying conditions that were not addressed.

Importance of Preoperative Imaging
In your grandmother's case, the reliance on X-rays alone may have contributed to the oversight of potential complications. While X-rays are useful for assessing bone structure, they may not provide sufficient detail about soft tissues or the presence of cracks in the vertebrae. Advanced imaging techniques, such as CT scans or MRIs, can offer a more comprehensive view of the spine, allowing for better preoperative planning and risk assessment.

1. CT Scans: A CT scan provides detailed cross-sectional images of the spine and can reveal fractures or other abnormalities that X-rays might miss. This could have helped identify any issues that might predispose your grandmother to complications during the procedure.

2. MRI: An MRI is particularly useful for assessing soft tissue and nerve involvement. It could have detected any pre-existing nerve compression or other issues that might have been exacerbated by the introduction of bone cement.

Addressing Postoperative Complications
Given the complications your grandmother experienced, it is essential to address her current condition. The immediate focus should be on managing her lower extremity paralysis. This may involve:
- Neurological Evaluation: A thorough assessment by a neurologist to determine the extent of nerve damage and potential for recovery.

- Physical Therapy: Engaging in rehabilitation to regain strength and mobility, tailored to her specific needs.

- Pain Management: Addressing any ongoing pain through medication or other interventions.

Seeking Compensation
If there is a belief that negligence occurred during the procedure, it may be appropriate to seek legal counsel to explore options for compensation. This could involve:
- Documenting Medical Records: Collecting all relevant medical records, including imaging studies, surgical notes, and postoperative care documentation.

- Consulting with a Medical Malpractice Attorney: An attorney specializing in medical malpractice can provide guidance on the viability of a claim based on the circumstances surrounding the surgery and the subsequent complications.

Conclusion
Bone cement surgery can be an effective treatment for vertebral compression fractures, but it carries inherent risks that must be communicated clearly to patients and their families. The use of advanced imaging techniques prior to surgery can help mitigate these risks. In the unfortunate event of complications, timely intervention and appropriate legal recourse may be necessary to address the situation. It is crucial to advocate for your grandmother's health and well-being as she navigates her recovery.

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