Download PDF
Semin intervent Radiol 2015; 32(02): 163-173
DOI: 10.1055/s-0035-1549447
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Complications in Musculoskeletal Intervention: Important Considerations

David T. Wang
1   Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Melissa Dubois
2   Division of Musculoskeletal Radiology, Froedtert & The Medical College, Milwaukee, Wisconsin
,
Sean M. Tutton
1   Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations
Further Information

Publication History

Publication Date:
28 May 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Musculoskeletal (MSK) intervention has proliferated in recent years among various subspecialties in medicine. Despite advancements in image guidance and percutaneous technique, the risk of complication has not been fully eliminated. Overall, complications in MSK interventions are rare, with bleeding and infection the most common encountered. Other complications are even rarer. This article reviews various complications unique to musculoskeletal interventions, assists the reader in understanding where pitfalls lie, and highlights ways to avoid them.

Keywords

complications - musculoskeletal - image-guided interventional radiology
 

  • References

  • 1 Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003; 14 (9, Pt 2) S199-S202
    CrossrefPubMedGoogle Scholar
  • 2 Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 2012; 125 (3) 265-269
    CrossrefPubMedGoogle Scholar
  • 3 Patel IJ, Davidson JC, Nikolic B , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (6) 727-736
    CrossrefPubMedGoogle Scholar
  • 4 Patel IJ, Davidson JC, Nikolic B , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement; Standards of Practice Committee of the Society of Interventional Radiology. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol 2013; 24 (5) 641-645
    CrossrefPubMedGoogle Scholar
  • 5 Foremny GB, Pretell-Mazzini J, Jose J, Subhawong TK. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 2015; 44 (5) 619-627
    CrossrefPubMedGoogle Scholar
  • 6 Newberg AH, Munn CS, Robbins AH. Complications of arthrography. Radiology 1985; 155 (3) 605-606
    CrossrefPubMedGoogle Scholar
  • 7 Nussbaum DA, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 2004; 15 (11) 1185-1192
    CrossrefPubMedGoogle Scholar
  • 8 Abdelrahman H, Siam AE, Shawky A, Ezzati A, Boehm H. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J 2013; 13 (12) 1809-1817
    CrossrefPubMedGoogle Scholar
  • 9 Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med 2006; 7 (1) 52-56
    CrossrefPubMedGoogle Scholar
  • 10 Bible JE, Biswas D, Whang PG, Simpson AK, Grauer JN. Which regions of the operating gown should be considered most sterile?. Clin Orthop Relat Res 2009; 467 (3) 825-830
    CrossrefPubMedGoogle Scholar
  • 11 Charalambous CP, Tryfonidis M, Sadiq S, Hirst P, Paul A. Septic arthritis following intra-articular steroid injection of the knee—a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol 2003; (22) 386-390
    PubMedGoogle Scholar
  • 12 Chan D, Downing D, Keough CE , et al. Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures: From the Society of Interventional Radiology, Association of periOperative Registered Nurses, and Association for Radiologic and Imaging Nursing, for the Society of Interventional Radiology, Standards of Practice Committee, and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2012; 23: 1603-1612
    CrossrefPubMedGoogle Scholar
  • 13 Vollman AT, Craig JG, Hulen R, Ahmed A, Zervos MJ, van Holsbeeck M. Review of three magnetic resonance arthrography related infections. World J Radiol 2013; 5 (2) 41-44
    CrossrefPubMedGoogle Scholar
  • 14 Casalegno JS, Le Bail Carval K, Eibach D , et al. High risk HPV contamination of endocavity vaginal ultrasound probes: an underestimated route of nosocomial infection?. PLoS ONE 2012; 7 (10) e48137
    CrossrefPubMedGoogle Scholar
  • 15 U.S. Food and Drug Administration. Update on bacteria found in ortho-sonic generic ultrasound transmission gel poses risk of infection: FDA Safety Communication. Available at: http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm299409.htm . Accessed December 23, 2014
    PubMedGoogle Scholar
  • 16 Kauffman CA, Pappas PG, Patterson TF. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med 2013; 368 (26) 2495-2500
    CrossrefPubMedGoogle Scholar
  • 17 “Lethal Medicine Linked To Meningitis Outbreak.” 60 Minutes. CBS. Aired 3/10/2013. Available at: http://www.cbsnews.com/news/lethal-medicine-linked-to-meningitis-outbreak-10-03-2013/ . Accessed December 23, 2014
    PubMedGoogle Scholar
  • 18 Venkatesan AM, Kundu S, Sacks D , et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol 2010; 21: 1611-1630
    CrossrefPubMedGoogle Scholar
  • 19 Cannon SR, Dyson PHP. Relationship of the site of open biopsy of malignant bone tumors to local recurrence following resection and prosthetic replacement. J Bone Joint Surg Br 1987; 69B: 492
    PubMedGoogle Scholar
  • 20 Davies NM, Livesley PJ, Cannon SR. Recurrence of an osteosarcoma in a needle biopsy track. J Bone Joint Surg Br 1993; 75 (6) 977-978
    PubMedGoogle Scholar
  • 21 Schwartz HS, Spengler DM. Needle tract recurrences after closed biopsy for sarcoma: three cases and review of the literature. Ann Surg Oncol 1997; 4 (3) 228-236
    CrossrefPubMedGoogle Scholar
  • 22 Saghieh S, Masrouha KZ, Musallam KM , et al. The risk of local recurrence along the core-needle biopsy tract in patients with bone sarcomas. Iowa Orthop J 2010; 30: 80-83
    PubMedGoogle Scholar
  • 23 Anderson MW, Temple HT, Dussault RG, Kaplan PA. Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors. AJR Am J Roentgenol 1999; 173 (6) 1663-1671
    CrossrefPubMedGoogle Scholar
  • 24 Gladden K, Spill GR. Iliac fracture after a bone marrow biopsy. PM R 2011; 3 (12) 1150-1152
    CrossrefPubMedGoogle Scholar
  • 25 Bain BJ. Morbidity associated with bone marrow aspiration and trephine biopsy - a review of UK data for 2004. Haematologica 2006; 91 (9) 1293-1294
    PubMedGoogle Scholar
  • 26 Stellon A, Davies A, Williams R. Avulsion of the anterior superior iliac spine complicating bone biopsy. Postgrad Med J 1985; 61 (717) 625-626
    CrossrefPubMedGoogle Scholar
  • 27 Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003; 226 (1) 119-124
    CrossrefPubMedGoogle Scholar
  • 28 Taylor RS, Fritzell P, Taylor RJ. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 2007; 16 (8) 1085-1100
    CrossrefPubMedGoogle Scholar
  • 29 Komemushi A, Tanigawa N, Kariya S , et al. Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 2006; 29 (4) 580-585
    CrossrefPubMedGoogle Scholar
  • 30 Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 2004; 25 (2) 175-180
    PubMedGoogle Scholar
  • 31 Moon ES, Kim HS, Park JO , et al. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved. Yonsei Med J 2007; 48 (4) 645-652
    CrossrefPubMedGoogle Scholar
  • 32 Laredo JD, Hamze B. Complications of percutaneous vertebroplasty and their prevention. Skeletal Radiol 2004; 33 (9) 493-505
    PubMedGoogle Scholar
  • 33 Pitton MB, Herber S, Bletz C , et al. CT-guided vertebroplasty in osteoprotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up. Eur Radiol 2008; 18 (1) 43-50
    CrossrefPubMedGoogle Scholar
  • 34 Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 2002; 96 (1, Suppl): 56-61
    PubMedGoogle Scholar
  • 35 Cotten A, Dewatre F, Cortet B , et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996; 200 (2) 525-530
    CrossrefPubMedGoogle Scholar
  • 36 Geraci G, Lo Iacono G, Lo Nigro C, Cannizzaro F, Cajozzo M, Modica G. Asymptomatic bone cement pulmonary embolism after vertebroplasty: case report and literature review. Case Rep Surg 2013; 2013: 591432
    PubMedGoogle Scholar
  • 37 Sharma R, Then P, Gupta S, Saini N, Saini Y. Cement Dislodgment After Percutaneous Vertebroplasty – A Rare Complication. The Internet Journal of Spine Surgery. 2012 Volume 6 (2). Available at: https://ispub.com/IJSS/6/2/14418 . Accessed November 20, 2014
    PubMedGoogle Scholar
  • 38 Stawicki SP, Moffatt-Bruce SD, Ahmed HM , et al. Retained surgical items: a problem yet to be solved. J Am Coll Surg 2013; 216 (1) 15-22
    CrossrefPubMedGoogle Scholar
  • 39 Tateishi M, Tomizawa Y. Intravascular foreign bodies: danger of unretrieved fragmented medical devices. J Artif Organs 2009; 12 (2) 80-89
    CrossrefPubMedGoogle Scholar
  • 40 Bain BJ. Bone marrow biopsy morbidity and mortality: 2002 data. Clin Lab Haematol 2004; 26 (5) 315-318
    CrossrefPubMedGoogle Scholar
  • 41 Huang AJ, Halpern EF, Rosenthal DI. Incidence of delayed complications following percutaneous CT-guided biopsy of bone and soft tissue lesions of the spine and extremities: a 2-year prospective study and analysis of risk factors. Skeletal Radiol 2013; 42 (1) 61-68
    CrossrefPubMedGoogle Scholar
  • 42 Goetz MP, Callstrom MR, Charboneau JW , et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 2004; 22 (2) 300-306
    CrossrefPubMedGoogle Scholar
  • 43 Nakatsuka A, Yamakado K, Maeda M , et al. Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies. J Vasc Interv Radiol 2004; 15 (7) 707-712
    CrossrefPubMedGoogle Scholar
  • 44 Kurup AN, Callstrom MR. Ablation of skeletal metastases: current status. J Vasc Interv Radiol 2010; 21 (8, Suppl): S242-S250
    CrossrefPubMedGoogle Scholar
  • 45 Philip A, Gupta S, Ahrar K, Tam AL. A spectrum of nerve injury after thermal ablation: a report of four cases and review of the literature. Cardiovasc Intervent Radiol 2013; 36 (5) 1427-1435
    CrossrefPubMedGoogle Scholar
  • 46 Tins B, Cassar-Pullicino V, McCall I, Cool P, Williams D, Mangham D. Radiofrequency ablation of chondroblastoma using a multi-tined expandable electrode system: initial results. Eur Radiol 2006; 16 (4) 804-810
    CrossrefPubMedGoogle Scholar
  • 47 Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. JAMA 1980; 243 (15) 1547-1548
    CrossrefPubMedGoogle Scholar
  • 48 Kumar N, Newman RJ. Complications of intra- and peri-articular steroid injections. Br J Gen Pract 1999; 49 (443) 465-466
    PubMedGoogle Scholar
  • 49 Mader R, Lavi I, Luboshitzky R. Evaluation of the pituitary-adrenal axis function following single intraarticular injection of methylprednisolone. Arthritis Rheum 2005; 52 (3) 924-928
    CrossrefPubMedGoogle Scholar
  • 50 Wicki J, Droz M, Cirafici L, Vallotton MB. Acute adrenal crisis in a patient treated with intraarticular steroid therapy. J Rheumatol 2000; 27 (2) 510-511
    PubMedGoogle Scholar
  • 51 Black DM, Filak AT. Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection. J Fam Pract 1989; 28 (4) 462-463
    PubMedGoogle Scholar
  • 52 Deer T, Ranson M, Kapural L, Diwan SA. Guidelines for the proper use of epidural steroid injections for the chronic pain patient. Tech Reg Anesth Pain Manage 2009; 13: 288-295
    PubMedGoogle Scholar
  • 53 Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M. Importance of placement of intra-articular steroid injections. BMJ 1993; 307 (6915) 1329-1330
    CrossrefPubMedGoogle Scholar
  • 54 Kim HJ, Park SH. Median nerve injuries caused by carpal tunnel injections. Korean J Pain 2014; 27 (2) 112-117
    CrossrefPubMedGoogle Scholar
  • 55 Benedetti EM, Siriwetchadarak R, Stanec J, Rosenquist RW. Epidural steroid injections: complications and management. Tech Reg Anesth Pain Manage 2009; 13: 236-250
    PubMedGoogle Scholar
  • 56 Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think?. Spine 2007; 32 (11) 1249-1256
    CrossrefPubMedGoogle Scholar
  • 57 Gharibo C, Koo C, Chung J, Muroz A. Epidural steroid injections: An update on mechanisms of injury and safety. Tech Reg Anesth Pain Manage 2009; 13: 266-271
    PubMedGoogle Scholar
  • 58 Lyders EM, Morris PP. A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol 2009; 30 (9) 1691-1693
    CrossrefPubMedGoogle Scholar
  • 59 Hau A, Kim I, Kattapuram S , et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31 (6) 349-353
    CrossrefPubMedGoogle Scholar
  • 60 Puri A, Shingade VU, Agarwal MG , et al. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 2006; 35 (3) 138-143
    CrossrefPubMedGoogle Scholar
  • 61 Le HBQ, Lee ST, Munk PL. Image-guided musculoskeletal biopsies. Semin Intervent Radiol 2010; 27 (2) 191-198
    Article in Thieme ConnectPubMedGoogle Scholar
  • 62 Welker JA, Henshaw RM, Jelinek J, Shmookler BM, Malawer MM. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer 2000; 89 (12) 2677-2686
    CrossrefPubMedGoogle Scholar