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

Kulkarni, Arvind G; Shah, Sambhav; Deopujari, C.E.

doi:10.1177/230949901302100320

Cited by 12 publications

(12 citation statements)

References 16 publications

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“…[ 9 , 14 – 17 ] Extremely rare intradural leakage can occur. [ 18 , 19 ] PVP can also increase the risk of fractures of adjacent vertebrae. [ 14 , 20 – 23 ] The incidence of postoperative infections is low.…”

Section: Introductionmentioning

confidence: 99%

Complications of percutaneous vertebroplasty

Saracen

Kotwica

2016

Medicine

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Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient—with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.

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Section: Introductionmentioning

confidence: 99%

Complications of percutaneous vertebroplasty

Saracen

Kotwica

2016

Medicine

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“…PVP in osteoporotic VCFs, involving the percutaneous injection of cement directly into the fractured vertebra, is effective in ameliorating VCF-associated pain [34–36]. The limitation of this procedure is the substantial risk of extravertebral cement leakage after high-pressure cement injection, with severe clinical complications including spinal cord compression [15, 37–40], radicular pain [41], and systemic embolism [42–46]. Local leakage of PMMA is frequent, and varies up to more than 70% [1, 47–51]; however, in most cases, the leakage does not produce any symptoms [47–49].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty

et al. 2019

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BackgroundThe risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated.MethodsThree thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded.ResultsType-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support.ConclusionsCement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.

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“…Decrease of vertebral body bone mineral density after spinal fusion surgery was demonstrated because of biomechanical stresses, postoperative immobilization and mineral metabolism [8]. Currently, percutaneous kyphoplasty and percutaneous vertebroplasty (PVP) surgery have become the standard [11,12]. Although the incidence of bone cement leakage following PKP surgery is significantly lower than that of PVP due to application of balloon Fig.…”

Section: Discussionmentioning

confidence: 99%

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report

Chang

et al. 2020

BMC Surg

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Background: Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. Case presentation: We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. Conclusions: We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

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

Cited by 12 publications

References 16 publications

Complications of percutaneous vertebroplasty

Complications of percutaneous vertebroplasty

Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report

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