Vertebral collapse and polymethylmethacrylate breakage after vertebroplasty

Abstract

Rationale: Vertebral augmentation has become the main treatment for osteoporotic vertebral fractures (VFs). In this article, we report a very rare case of vertebral collapse and polymethylmethacrylate (PMMA) breakage after vertebroplasty. We describe the clinical characteristics and revision surgery performed to remove the broken PMMA cement, maintain stability, and corrects the kyphotic deformity, and we analyze the possible causes. Patient concerns: A 72-year-old man who suffered back pain underwent first lumbar vertebra (L1) percutaneous vertebroplasty (PVP) due to osteoporosis and a vertebral fracture in May 2013. Postoperatively, the patient's back pain was markedly alleviated. Unfortunately, his lumbar back pain recurred in November 2015. Diagnoses: Plain radiographs showed collapse of the L1 vertebral body, breakage of the PMMA cement, and severe kyphosis at the thoracolumbar junction. Interventions: The posterior pedicle was internally fixed and an anterior artificial vertebral body implant was placed to maintain stability and correct the kyphotic deformity in a 2-step surgical procedure. Outcomes: The back pain was alleviated and the patient returned to daily life for more than two years. Lessons: This case demonstrates that PVP is not a simple minimally invasive surgery, and significant postsurgical care is necessary. The true cause of this rare phenomenon remains unclear, but the long-term use of steroids, new injuries, and poorly corrected kyphosis after PVP may play a role. Surgeons must be aware of the kinds of complications that may occur, including rare complications such as vertebral lysis.

Cement Plug Fragmentation Following Percutaneous Cementoplasty of the Bony Pelvis: Is it a Frequent Finding in Clinical Practice?

“…2). According to descriptions in the literature, fragmentation of PMMA was recorded in case of an apparition of a fracture line inside the cement plug and/or if the shape of PMMA was modified and/or if PMMA was identified distant to the original volume [11,19,20]. Should fragmentation be present, the filling rate of the osteolysis was calculated using volumetric evaluation, and the entire patient's medical history was reviewed in order to look for signs of local infection and assess the pain level using the visual analog score before the intervention and at the last clinical evaluation [21].…”

“…Most of the data on the causes and consequences of cement fragmentation come from the orthopedic literature, as loosening and failure of arthroplasties are relevant clinical issues [17,18]. There are only sporadic case reports of PMMA breakages in the spine following vertebroplasty [12,19,20]. Although it does not seem to be a frequent clinical problem, literature on cement fragmentation after percutaneous cementoplasty in the bony pelvis is still lacking.…”