Acute Paraplegia After Vertebroplasty Caused by Epidural Hemorrhage

Abstract

Vertebroplasty is widely used for the palliative stabilization of osteoporotic fractures and vertebral metastases. Serious complications with this procedure are rare and, as a result, vertebroplasty is being performed increasingly in hospitals without a spinal surgery unit or even in radiology practices where such complications may not be managed adequately when they arise. The leakage of cement into draining veins is the most frequent complication1,2, followed by cement penetration into the spinal canal. Fatal pulmonary embolism has been reported, and small cement emboli are not uncommon1,3. When cement penetration into the spinal canal causes a neurological deficit, decompression and often removal of the cement are required. The case of a patient who had an epidural hematoma after kyphoplasty associated with the postoperative administration of an intravenous heparin bolus has been described4. We report the case of a patient who had an acute epidural hemorrhage causing paraplegia as a complication from vertebroplasty. To the best of our knowledge, this is the first such report. The patient was informed that data concerning the case would be submitted for publication. An eighty-two-year-old woman with intractable back pain was transferred to our service from another hospital. A diagnosis of osteoporosis had been made following multiple vertebral fractures that had occurred approximately one year before and from which she had fully recovered after treatment with oral analgesics, calcium, vitamin D, and use of a brace. When renewed back pain developed, she first had received outpatient therapy with a variety of orally administered analgesics, including opioids for about five weeks, and oral alendronate (70 mg once per week). At the time of transfer to our department, she was receiving high doses of narcotic analgesics both orally and intravenously, but she was still immobilized because of pain. …