Delayed complications of intradural cement leakage after percutaneous vertebroplasty: A case report

Thoracic spinal cord injury and paraplegia caused by intradural cement leakage after percutaneous kyphoplasty: A case report

BACKGROUND

Percutaneous kyphoplasty (PKP) is a pivotal intervention for osteoporotic fractures, pathological vertebral compression fractures, and vertebral bone tumors. Despite its efficacy, the procedure presents challenges, notably complications arising from intradural cement leakage. Timely and accurate diagnosis, coupled with emergent intervention is imperative to improve patient prognosis. This case report illuminates the intricacies and potential complications associated with PKP, emphasizing the critical need for vigilant monitoring, prompt diagnosis, and immediate intervention to mitigate adverse outcomes.

CASE SUMMARY

A 58-year-old male patient, experiencing a T7 osteoporosis-related pathological compression fracture, underwent PKP at a local hospital. Two weeks post-procedure, the patient developed paraplegic and dysuric symptoms, necessitating emergency decompression surgery. Gradual improvement was achieved, marked by the restoration of muscle strength, sensation, and mobility.

CONCLUSION

PKP Intradural cement leakage following PKP is unusual and potentially fatal. Prompt imaging examinations, urgent evaluation, and the decompression surgery are essential, which help alleviate symptoms associated with spinal damage, markedly improving the overall prognosis.

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

Percutaneous vertebroplasty (PV) can be applied widely from osteoporotic to metastatic fractures. Pain, radiculopathy, spinal cord compression, pulmonary embolism, and infection are common complications of this procedure. However, rare complications such as intradural cement leakage have also been reported. There is little or no data on the results obtained after the late intervention. In addition, the midline total laminectomy method, which is the classical method, was predominantly used in intradural cement leaks after PV. We would like to report a 69-year-old female patient who underwent vertebroplasty for her L1 osteoporotic fracture about 3 months ago in an external center and subsequently developed paresis. The patient's surgery was successfully performed without the need for stabilization by hemilaminectomy. The improvement in the clinical findings of our case despite the late decompression shows that surgery is the most satisfactory option in such patients. As a surgical method, total excision can be achieved with the posterior hemilaminectomy approach.