J Korean Orthop Assoc.  2009 Jun;44(3):386-390. 10.4055/jkoa.2009.44.3.386.

Spinal Cord Injury Caused by Bone Cement after Percutaneous Vertebroplasty : One Case of Long-term Follow-up and the Result of Delayed Removal

• Ahn DK
• Choi DJ
• Lee S
• Kim KS
• Kim TW
• Chun TH

• KMID: 2186348
• DOI: http://doi.org/10.4055/jkoa.2009.44.3.386

Abstract

Among the complications of percutaneous vertebroplasty, bone cement leakage into the spinal canal doesn't happen very often, but this could provoke a severe neurologic deficit. It is not certain whether this neurologic deficit may be permanent or reversible. Yet if the bone cement is left in the spinal canal, trivial events such as minor trauma could worsen the neurologic symptoms. The authors treated a 75-year-old female patient with Nurick's grade IV neurologic deficit, which was due to cement leakage into the spinal canal after previous vertebroplasty of T8 and T9. She had been having a neurologic deficit for 9 years, and it became aggravated after a minor trauma to Nurick's grade V. After the cement in the spinal canal was removed, her neurologic symptoms were improved to Nurick's grade II. Leaving a cement mass in the spinal canal may be a risk factor for additional neurologic injury even when suffering only a minor trauma, and the neurologic symptoms can be improved after removal of the cement, even for the case with a long-term neurological defect.

Keyword

Vertebroplasty; Leakage; Additional injury

MeSH Terms

Aged
Female
Follow-Up Studies
Humans
Neurologic Manifestations
Risk Factors
Spinal Canal
Spinal Cord
Spinal Cord Injuries
Stress, Psychological
Vertebroplasty

Figure

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  Fig. 1 This graph shows progression and improvement of pain and neurologic symptom, which had been sustained for 9 years and aggravated abruptly after a minor trauma. Symptoms were improved rather than that of the previous state after cement removal.

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  Fig. 2 (A) Preoperative radiographs show extravasation of PMMA around T8, 9 and L1. (B) Preoperative MRI's show extravasation of PMMA which compresses spinal cord and encompasses spinal nerve roots.

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  Fig. 3 Schematic illustration shows laminectomy and subtraction of pedicles and posterior portion of the vertebral body. After that, bone cement can be easily removed without spinal cord retraction.

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  Fig. 4 (A) Intraoperative photograph shows that there was no evidence of burn injury on the duramater. (B) Bone cement was removed into a piecemeal pattern.

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  Fig. 5 (A, B) Postoperative radiographs and MRI's show that bone cement was removed from spinal canal and posterior stabilization was performed.

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