J Korean Soc Spine Surg.  2011 Sep;18(3):169-173.

Delayed Paraplegia after Successful Percutaneous Vertebroplasty in a Patient with Osteoporotic Compression Fracture: A Case Report

• Kim YC
• Son WS
• Suh BK
• Chung NS
• Kim SW

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
We report a case of a female patient initially diagnosed as osteoporotic vertebral fracture without any noticeable injuries to posterior ligament complex, who later developed with incomplete paraplegia resulting from an unrecognized trauma after vertebroplasty. SUMMARY OF LITERATURE REVIEW: Vertebroplasty remains a safe and effective procedure for osteoporotic vertebral fracture. However, there have been many reports regarding neural injury associated with cement leakage.
MATERIALS AND METHODS
An 81-year old woman with a sudden motor weakness and a sensory loss on her lower extremities after an unrecognized trauma was admitted to our clinic. She had undergone a vertebroplasty twelve days before the admission. At the time of vertebroplasty, Magnetic resonance (MR) imaging showed a compression fracture at T10 vertebra without any posterior ligament complex (PLC) injury. Follow up MR imaging was taken 12 days after vertebroplasty, and it revealed posterior shift of T10 body with a fracture of spinous process, tear of left facet joint capsule, partial tear of interspinous ligament of T10-11 with retrolisthesis, and narrowing of spinal canal at T10-11 by T11 lamina.
RESULTS
Immediate surgical treatment was performed to decompress the neural structures, and to stabilize the spinal column. However, neurological recovery was unsatisfactory.
CONCLUSIONS
Spinal surgeons should be aware of the possibility of the development of any neurologic deterioration, even if successful vertebroplasty is performed.

Keyword

Paraplegia; Vertebroplasty; Osteoporosis; Compression fracture

MeSH Terms

Female
Follow-Up Studies
Fractures, Compression
Humans
Ligaments
Lower Extremity
Magnetic Resonance Spectroscopy
Osteoporosis
Paraplegia
Spinal Canal
Spine
Vertebroplasty
Zygapophyseal Joint

Figure

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  Fig. 1. Plain radiograph on 1st admission. Recent benign compression fracture of T10 body (black arrow), multiple old compression fractures of T11, T12, L1, L2, L4, and L5 with moderate kyphosis.

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  Fig. 2. MRI on 1st admission. Recent benign compression fracture of T10 body. Signal change of spinous process of T10 which suggests bone marrow edema. Multiple old compression fractures of T11, T12.

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  Fig. 3. Percutaneous vertebroplasty on T10 body.

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  Fig. 4. CT on 2nd admission. Postoperatice state of T10 body. Posterior shift of T10 segment with a fracture of spinous process. Retrolisthesis of T10-11 with rotator subluxation. Subluxation of the bilateral facet joints of T10-11. Narrowing of spinal canal at T10-11.

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  Fig. 5. MRI on 2nd admission.(A) Posterior shift of T10 segment with fracture of spinous process, tear of left facet joint capsule, interspinous ligament of T10-11 with retrolisthesis. Narrowing of spinal canal at T10-11 by T11 lamina.(B) Narrowing of the spinal canal with spinal cord compression by ossification of yellow ligament (OYL) at T11-12.

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  Fig. 6. Intraoperative image on 2nd admission. There is no remarkable injury of Supraspinous ligament.

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