Neurological deficit due to cement extravasation following a vertebral augmentation procedure

Case report

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The authors endeavor to highlight the surgical management of severe neurological deficit resulting from cement leakage after percutaneous vertebroplasty and to systematically review the literature on the management of this complication.

A patient presented after a vertebroplasty procedure for traumatic injury. A CT scan showed polymethylmethacrylate leakage into the right foramina at T-11 and L-1 and associated central stenosis at L-1. He underwent decompression and fusion for removal of cement and stabilization of the fracture segment. In the authors' systematic review, they searched Medline, Scopus, and Cochrane databases to determine the overall number of reported cases of neurological deficit after cement leakage, and they collected data on symptom onset, clinical presentation, surgical management, and outcome.

After surgery, despite neurological recovery postoperatively, the patient developed pneumonia and died 16 days after surgery. The literature review showed 21 cases of cement extravasation with neurological deficit. Ultimately, 15 patients had resolution of the postoperative deficit, 5 had limited change in neurological status, and 2 had no improvement.

Cement augmentation procedures are relatively safe, but certain precautions should be taken to avoid such complications including high-resolution biplanar fluoroscopy, considering the use of a local anesthetic, and controlling the location of cement spread in relationship to the posterior vertebral body. Immediate surgical intervention with removal of cement provides good results with complete recovery in most cases.

Abbreviations used in this paper:BKP = balloon kyphoplasty; PMMA = polymethylmethacrylate; PVP = percutaneous vertebroplasty.

Article Information

Address correspondence to: Gursukhman Sidhu, M.B.B.S., Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, Pennsylvania 19107. email: Gursukh mansidhu@yahoo.co.uk

Please include this information when citing this paper: published online May 3, 2013; DOI: 10.3171/2013.4.SPINE12978.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: Preoperative midsagittal CT image demonstrating PMMA filling the posterior aspect of the spinal canal between T-11 and L-1. B: Preoperative axial CT image at the T12–L1 disc space revealing right neural foramen compression (arrow). C: Preoperative axial CT image at L-1 demonstrating partial filling of the posterior vertebral body by PMMA (arrow). There is greater than 50% central stenosis being caused by the extravasated cement.

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    Axial CT image of the chest showing PMMA emboli within a pulmonary arterial branch (arrow).

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    Anteroposterior radiograph (A), axial CT scans of T-12 (B) and L-1 (C), and midsagittal CT image (D) of the lumbar spine after removal of epidural bone cement, decompression, and placement of instrumentation.

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    Flow chart illustrating study selection.

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