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

• Published in: BMC musculoskeletal disorders 2021-08, Vol.22 (1), p.741-741, Article 741
• Main Authors: Baek, In-Hwa, Park, Hyung-Youl, Kim, Ki-Won, Jang, Tae-Yang, Lee, Jun-Seok
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Anemia; Back pain; Bone Cements - adverse effects; Bone surgery; Care and treatment; Case Report; Case reports; Causes of; Cement; Cement leakage; Complication; Complications and side effects; Compression; Computed tomography; Decompression; Diagnosis; Epidural; Female; Fractures; Humans; Intradural; Laboratories; Leakage; Leg; Literature reviews; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Magnetic resonance imaging; Medical imaging; Muscle strength; Musculoskeletal diseases; Osteoporosis; Pain; Paralysis; Paraplegia; Patients; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Radiography; Spinal cord; Surgery; Surgical techniques; Vertebroplasty; Vertebroplasty - adverse effects
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-021-04625-7

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. 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. 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.