Rare Complication of Percutaneous Technique: Intradural Cement Leakage and Its Surgical Treatment

Grelat, Michaël; Van, Tuan Le; Fahed, Elie; Beaurain, Jacques; Madkouri, Rachid

doi:10.1016/j.wneu.2018.07.045

Cited by 13 publications

(16 citation statements)

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“…In terms of treatment, surgery for decompression and cement removal should be recommended for patients with intradural cement leakage. Because improvements in neurological deficits were observed in six patients undergoing surgery including present case [ 1 , 6 , 12 – 15 ]. However, Chen et al [ 10 ] has reported that neurological deficit was sustained in one patient who refused open surgery because of old age.…”

Section: Discussionmentioning

confidence: 99%

“…However, cement leakage into the intradural space after VP is very rare [ 11 , 26 ]. To the best of our knowledge, it has been reported only in 7 cases (Table 1 ) [ 1 , 6 , 10 , 12 – 15 ]. Above all, it is difficult to diagnose whether cement leakage is intradural or epidural by conventional radiography.…”

Section: Discussionmentioning

confidence: 99%

“…However, cement leakage into the spinal canal can cause serious complications such as paraplegia by compressing the spinal cord [ 11 ]. Moreover, cement leakage to intradural space can cause catastrophic complications, although very rare [ 1 , 6 , 10 , 12 – 15 ]. We report here a case of intradural cement leakage following percutaneous VP with a literature review.…”

Section: Introductionmentioning

confidence: 99%

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

Baek

Park

Kim

et al. 2021

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Baek

Park

Kim

et al. 2021

BMC Musculoskelet Disord

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“…In addition, cement could also leak into the intervertebral disc, prevertebral veins, spinal canal, and epidural veins [54]. Cement entering the venous system and the spinal canal is the major potential risk [55,56]. In other parts of the body the leakage of the adhesive material entails less risks to damage the nerve, albeit it is more likely to enter the circulatory system, as embolization of the inferior vena cava or pulmonary artery.…”

Section: Discussionmentioning

confidence: 99%

Analgesia from percutaneous thermal ablation plus cementoplasty for cancer bone metastases

Sun

Zhang

et al. 2019

Journal of Bone Oncology

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BackgroundThe purpose of this study was to review recent research related to the analgesic effect of ablation therapy combined with cementoplasty, as well as to identify the duration of analgesic effect and risk for cement leaks.MethodsA systematic literature search using PubMed, Web of Science, and annual meeting proceedings of the oncology society and other organizations were conducted.ResultsTwelve retrospective studies met the inclusion criteria. Four of the studies included in the review assessed the changes immediately after treatment. Five studies were subjected to analyses of analgesic effect of combined percutaneous thermal ablation and Cementoplasty at 24 weeks after treatment. Incidences of leakage of bone cement during surgery were detected in 4 out of 12 studies. The change of mean pain scores at 1 days, at 1 week, and at 4 weeks, 12 weeks, and 24 weeks after treatment were −3.90 (95% CI: −4.80 to −3.00), −4.55 (95% CI:−5.46 to −3.64), −4.78 (95% CI: −5.70 to −3.86), −5.16 (95% CI: −6.39 to −3.92), and −5.91 (95% CI: −6.63 to −5.19). The relative risk of cement leakage was 0.10 (95% CI: −6.63 to −5.19).ConclusionsOur systematic review suggested that thermal ablation combined with cementoplasty could be a safe and effective intervention for the management of bone metastases-induced pain.

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“…However, PKP has the potential risk of several surgical complications, the most common of which is bone cement leakage. Although most cases are asymptomatic, some severe cases of cement leakage into the spinal canal, dura, or intervertebral foramen may cause neurological dysfunction or pulmonary embolism, and can be life-threatening [2][3][4]. To our knowledge, we present the rare reported case of an 81-year-old woman who suffered epidural cement leakage following PKP in the same vertebra with pedicle screws and clarify the most likely etiologies, clinical signs, and treatments of this rare condition.…”

Section: Introductionmentioning

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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Rare Complication of Percutaneous Technique: Intradural Cement Leakage and Its Surgical Treatment

Cited by 13 publications

References 0 publications

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

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

Analgesia from percutaneous thermal ablation plus cementoplasty for cancer bone metastases

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

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