Abstract
Accidental rupture of the inflatable bone tamp is a rare but possible complication during balloon kyphoplasty. We describe an easy and minimal invasive technique to remove this foreign body from fractured vertebra. A 62-year-old female patient with severe osteoporosis had a low energy trauma and sustained burst fracture of the 12th thoracic (Th12) vertebra. The inflated bone tamp was not possible to be fully deflated and during the maneuvers to withdraw the balloon, it was disassembled and trapped under the distal end of working cannula, remaining within the bone cavity formed by balloon. Since no standard recommendation for this complication exists in current literature, we faced the dilemma of either leaving ruptured bone tamp in situ or removing it with a more extensive approach. We decided to use an alternative minimal invasive technique and managed to remove it through the right pedicle using a small size straight pituitary rongeur forceps under biplane continuous image intensifier and neuromonitoring. Subsequently, balloon kyphoplasty (BK) was performed through the left cannula accompanied with pedicle screw fixation of the adjacent vertebrae. The patient was followed up to our outpatient department for one year without complications. This extremely rare complication during BK consists of a challenge for spine surgeons and interventional radiologists. The described technique is relatively easy, safe, minimal invasive, time-saving and avoids further complications related with trapping of foreign bodies within the vertebral body.
Highlights
Reported incidence of low-energy osteoporotic vertebral fractures in the United States is estimated to be more than 500,000 new cases per year, while an increase of more than 50% is expected by 2025 [1]
Simple, minimal invasive and safe technique to remove broken balloon from fractured vertebra during balloon kyphoplasty (BK)
This technique allows the removal of foreign bodies from vertebral body with no additional risks and the possibility of spinal infection is eliminated
Summary
Reported incidence of low-energy osteoporotic vertebral fractures in the United States is estimated to be more than 500,000 new cases per year, while an increase of more than 50% is expected by 2025 [1]. BK has specific complications such as balloon rupture, retained balloon in vertebral body, partial needle retention, cortical fracture of vertebral endplates during balloon inflation, re-collapse following balloon deflation and transient hyperalgesia after PMMA injection [3,4,5] Another extremely rare but potentially fatal complication is spinal infection (0.46%) associated with vertebral augmentation, which often necessitates major spine surgery [5]. Simple, minimal invasive and safe technique to remove broken balloon from fractured vertebra during BK This technique allows the removal of foreign bodies from vertebral body with no additional risks and the possibility of spinal infection is eliminated. The patient was followed up in the outpatient clinic for 12 months without any neurological complications or infection
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