Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review

Abstract

Background Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. Case presentation An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. Conlcusions If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

Can neurological recovery occur after late decompression of an intradural cement leakage?

“…Limited data in the literature on cases operated in the later period. [ 7 , 8 ] In our case, the operation was performed after a very long period (3 rd month) with the posterior hemilaminectomy approach, thus avoiding instability and the need for stabilization. However, there is also a chance that the patient may develop delayed kyphosis despite the minimally invasive approach that was taken.…”

Enhancing percutaneous kyphoplasty efficacy in elderly osteoporotic fractures through optimal cement filling ratio

“…At the same time, excessive bone cement infusion can result in leakage events. In severe instances, the bone cement entering the spinal canal might compress nerve tissue, potentially causing paralysis in the patient (27). Therefore, an appropriate proportion of cement infusion in PKP can yield good patient outcomes and reduce the incidence of clinical adverse events.…”

Current status and challenges of percutaneous vertebroplasty (PVP)

“…Lee et al reported in their meta-analysis that symptomatic cement leakage occurs in 1.08% [ 79 ]. Complications associated with bone cement leakage include pulmonary cement embolism [ 62 , 69 , 88 ], cardiac cement embolism [ 63 , 70 ], bilateral lower limb paraplegia due to intravertebral canal cement leakage [ 55 , 59 , 89 , 90 ], and a cement-embolic cerebral infarction [ 84 ], which are described below.…”

“…To prevent these complications, penetration of the inside of the pedicle should be avoided, and the viscosity of the PMMA must be monitored. Immediate spinal canal decompression surgery is recommended when paraplegia is due to a space-occupying lesion in the spinal canal [ 59 – 61 , 89 , 90 , 94 ].…”