Complications of vertebral augmentation in metastatic spinal fractures: a systematic review of multiple study designs.

Authors

Maria Clara Correia, Ana Margarida Vieira, Filipe Duarte, André Rodrigues Pinho, Francisco Serdoura, Maria João Leite

Published in

Journal of bone oncology. Volume 61. Pages 100802. Epub Sep 15, 2026.

Abstract

Vertebral augmentation techniques, including vertebroplasty and kyphoplasty, are widely used to relieve pain and restore spinal stability in patients with metastatic vertebral lesions. Despite their widespread use, the full spectrum and clinical significance of procedure-related complications remain incompletely characterised. This systematic review aims to summarise and characterise all reported complications associated with vertebral augmentation for metastatic thoracolumbar disease.
A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases was performed. Studies reporting complications associated with vertebral augmentation procedures for metastatic thoracolumbar spinal fractures were included. Randomised controlled trials, observational studies, case series, and case reports were eligible. Due to substantial heterogeneity across studies, a descriptive synthesis was performed.
A total of 76 studies were included, comprising 3234 patients and at least 5737 vertebral levels treated. The overall weighted complication rate was 25.5%, while the weighted rate of symptomatic complications was 3.41%. Cement leakage was the most frequently reported complication, with a weighted mean incidence of 20.7%, although the majority were asymptomatic. Other complications included postprocedural pain (1.77%), pulmonary cement embolism (1.08%), and adjacent level fractures (0.79%). Studies using CT imaging reported significantly higher cement leakage rates (28.6% vs 11.9%, p = 0.004). Case reports described rare but potentially severe complications, including needle-tract tumour seeding, tumour extrusion, and cement migration to cardiac structures.
This review presents a comprehensive and detailed description of all complications of vertebral augmentation for treatment of metastatic spine disease and reinforce its safety. Differences in imaging protocols and reporting standards contribute to variability in reported complication rates. Further prospective studies with standardised complication reporting are needed.

PMID:
42780331
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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