Balloon Kyphoplasty Complication: A Case of a Lodged Balloon Within the Vertebral Body

Abstract

This report describes a case involving a balloon kyphoplasty bone tamp becoming lodged inside the vertebral body and unable to be withdrawn, the first report of its kind in the literature. A board certified interventional pain management physician was performing a balloon kyphoplasty for an L3 osteoporotic vertebral compression fracture using a bipedicular approach with two bone tamps. Cannulation and cavity formation were completed without complication; however, upon removal of the balloons it was noted that one had become lodged in the vertebral body. Several attempts were made to remove the balloon. Neurosurgery and the balloon manufacturer were consulted intraoperative, and it was decided to leave the balloon fragments in situ and complete the interventional fixation of the vertebral body with bone cement. The patient followed up in the clinic several months later without neurologic complications. Postoperative radiography confirmed the presence of a retained foreign body consistent with balloon fragments. Balloon kyphoplasty and its various procedural complications will be discussed, as well as the intraoperative decision making faced when encountering a complication.

A Smart Technique to Remove Ruptured Inflatable Bone Tamp From the Vertebral Body in Balloon Kyphoplasty

“…They followed the patient 12 months postoperatively, but no neurologic complications or complaints were reported. In contrast with Chalhoub et al [3] and Shah et al [9] who decided to retain bone tamp and needle respectively inside the lumbar vertebral body, we removed the completely broken and deflated bone tamp, because we were skeptic that this foreign object might act as source for a future spinal infection in this elderly woman. Spinal infection is a potential lifethreatening situation, which requires a major surgery, prolonged hospitalization and increased health costs.…”

“…The most common complications associated with VP and BK are the following: PMMA leakage, peripheral & lung embolism, persistent pain, adjacent and remote fractures [ 6 ]. Established short-term complications of BK are also cortical fracture of vertebral endplates during balloon inflation, re-collapse of the vertebral fracture after balloon deflation, balloon rupture during inflation and transient hyperalgesia after PMMA injection due to the exothermic reaction of cement [ 3 ]. However, there are some rare and potential life-threatening complications associated with VP or BK, such as spinal infection that may pose serious dilemmas for spine surgeons [ 5 ].…”

“…During the maneuvers to deflate and withdraw the tamp, it broke and was disassembled from the flexible kyphoplasty guiding tube, remaining within the void created by the balloon (Figure 4). Since no standard recommendation exists to front this complication, the real alternatives were either leaving in situ the tamp as retained foreign object within the vertebral body [3,7] or removing it via an anterior [5] or posterior approach. Finally, the pedicle was dilated via the hand drill and using a small size pituitary rongeur forceps (10 millimetres total diameter) under biplane continuous image intensifier and neuromonitoring, we caught the deflated tamp and removed it (Figures 5, 6).…”

“…Leakage to the spinal canal occurs less often but it could be potentially disastrous with irreversible damage to spinal cord. BK has specific complications such as balloon rupture, retained balloon in vertebral body, partial needle retention, cortical fracture of vertebral endplates during balloon inflation, re-collapse following balloon deflation and transient hyperalgesia after PMMA injection [3][4][5]. Another extremely rare but potentially fatal complication is spinal infection (0.46%) associated with vertebral augmentation, which often necessitates major spine surgery [5].…”

“…Percutaneous BK utilizes an inflatable balloon bone tamp to reduce the compressed upper vertebral endplate, restore the anterior vertebral body height and create a cavity in the fractured vertebral body for polymethacrylate (PMMA) injection. Extra-canal PMMA leakage is a common complication during BK with incidence rates of approximately 18.4% [ 3 , 4 ]. Leakage to the spinal canal occurs less often but it could be potentially disastrous with irreversible damage to spinal cord.…”