Cement Leakage into the Posterior Spinal Canal during Balloon Kyphoplasty: A Case Report

Becker, Stephan; Meissner, J; Tuschel, A; Chavanne, A; Ogon, M

doi:10.1177/230949900701500220

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…The use of inflatable bone tamps (IBT) has aided kyphoplasty procedures in restoring the vertebral height and reducing cement extravasation rates 3,10) . Although the procedure is a minimally-invasive, percutaneous technique, the cement augmentation procedure itself is associated with intra-and postoperative complications 2,11) . The optimal timing of balloon kyphoplasty with regard to an injury has not been determined.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Results of Balloon Kyphoplasty Performed at Different Times after Injury

Kim

et al. 2010

J Korean Neurosurg Soc

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Objective : Balloon kyphoplasty is a minimally invasive procedure that is mainly performed for refractory pain due to osteoporotic compression fractures. The purpose of this study was to evaluate the results of balloon kyphoplasty performed at different times after an injury. Methods : In this retrospective study, the records of 99 patients who underwent one level of balloon kyphoplasty between January 2005 and December 2007 were reviewed. The patients were divided into three groups : 21 patients treated within 3 weeks of an injury (the acute group), 49 treated within 3 weeks to 2 months of an injury (the subacute group), and 29 patients treated at more than 2 months after an injury (the chronic group). Clinical outcomes were assessed using a visual analogue scale (VAS). In addition, modified MacNab's grading criteria was used to assess the subjective patient outcome. The radiology findings, including vertebral height restoration and procedure related complications, were analyzed based on the different time intervals after the injury. Results : Patients in all three groups achieved marked pain relief in terms of the VAS within 7 days of the procedure. Good or excellent results were achieved by most patients in all three groups. However, the height restoration, the main advantage to performing a balloon kyphoplasty, was not achieved in the chronic group. Moreover, evidence of complications including cement leakage was observed significantly less frequently in the subacute group compared to the other two groups. Conclusion : Although balloon kyphoplasty is an effective treatment for osteoporotic compression fractures, with regard to pain relief, the subacute stage appears to be optimal for treating patients with a balloon kyphoplasty in terms of achieving the best outcomes with minimal complications.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Results of Balloon Kyphoplasty Performed at Different Times after Injury

Kim

et al. 2010

J Korean Neurosurg Soc

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“…11 Immediate surgical decompression and removal of cement is necessary. 12 Cement leakage into the spinal canal, neural foramina, and disc space may occur following 11 to 73% of vertebroplasty procedures. 8 Only 3 cases of intradural cement leakage have been reported.…”

Section: Discussionmentioning

confidence: 99%

Epidural and Intradural Cement Leakage following Percutaneous Vertebroplasty: A Case Report

Kulkarni

Shah

Deopujari

2013

J Orthop Surg (Hong Kong)

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A 48-year-old woman presented with severe bilateral leg pain, urinary incontinence, and paraparesis following vertebroplasty in another hospital 15 days earlier. Computed tomography and magnetic resonance imaging showed blocks of epidural and intradural cement from T12 to L1 with neurological compression. She underwent corpectomy of L1 and removal of extradural cement, followed by anterior reconstruction with an expandable cage and dual rodscrew construct (Kaneda system). Postoperatively, the patient had minimal improvement in leg pain and neurological deficit. Computed tomographic myelography was therefore performed and revealed complete blockage, which is suspected to be due to intradural cement leakage. The patient underwent posterior durotomy and removal of the cement. Postoperatively, the patient reported immediate pain relief. Her neurological status gradually improved over months. At the 2-year follow-up, the patient was able to walk with support and to perform activities of Epidural and intradural cement leakage following percutaneous vertebroplasty: a case report

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“…Many factors contributing to the occurrence of intracanal leakage of PMMA were reported, such as viscosity of PMMA, 6 amount of PMMA injected, 7 bilateral or unilateral pedicular approach, 3,7 period of PVP after injury, 8 adequate intraoperative radiograph, 9 and preoperative verification of the fracture pattern (posterior wall or pedicle fracture). 10 In this case, viscosity of injected PMMA must have been low, and amount of injected PMMA must have been too much because the leaked PMMA was spread around the spinal canal and spread into the caudal vertebral level and into the segmental vein and pulmonary artery.…”

Section: Discussionmentioning

confidence: 99%

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2017

Surg J

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JapanSurg J 2017;3:e1-e5.Address for correspondence Yoichiro Takata, MD, PhD, Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan (e-mail: yoichiro76@tokushima-u.ac.jp). Keywords► percutaneous vertebroplasty ► cement leakage ► neurologic deficit ► surgical removal AbstractBackground The major complication of percutaneous vertebroplasty (PVP) using polymethyl methacrylate (PMMA) is epidural leakage of PMMA that damages the spinal cord. Methods This is a case report. Result A 77-year-old man presented to our institution with a 6-month history of muscle weakness and an intolerable burning sensation of both lower limbs after PVP with PMMA for thoracic compression fracture at T7 at another hospital. His past medical history was significant for hypertension. He had no history of smoking and alcohol. Computed tomography revealed massive leakage of PMMA into the T6 and T7 spinal canal circumferentially surrounding the spinal cord that caused marked encroachment of the thecal sac. Magnetic resonance images revealed cord compression and intramedullary signal change from T6 to T7 level. After we verified that the leaked PMMA could be easily detached from the dura mater in the cadaveric lumbar spine, surgical decompression and removal of epidural PMMA was performed. The leaked PMMA was carefully thinned down with a high-speed diamond burr. Eight pieces of PMMA were detached from the dura mater easily without causing a dural tear. No neurologic deterioration was observed in the postoperative period. The burning sensation resolved, but the muscle weakness remained unchanged. One and a half years postoperatively, the muscle weakness has improved to ⅘ on the manual muscle strength test, but he could not walk without an aid because of spasticity. Conclusion This report demonstrates the catastrophic epidural extrusion of PMMA following PVP. Extravasated PMMA can be removed through a working space created by means of laminectomy and subtraction of the affected pedicle. Spine surgeons should recognize the possible neurologic complications of PVP and be prepared to treat them using suitable approaches.

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Cement Leakage into the Posterior Spinal Canal during Balloon Kyphoplasty: A Case Report

Cited by 17 publications

References 14 publications

Comparison of the Results of Balloon Kyphoplasty Performed at Different Times after Injury

Comparison of the Results of Balloon Kyphoplasty Performed at Different Times after Injury

Epidural and Intradural Cement Leakage following Percutaneous Vertebroplasty: A Case Report

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