Abstract
Kyphoplasty is advantageous over vertebroplasty in terms of better kyphosis correction and diminished risk of cement extravasations. Literature described cement leakage causing neurological injury mainly after vertebroplasty procedure; only a few case reports show cement leakage with kyphoplasty without neurological injury or proper cause of leakage. We present a report two cases of osteoporotic vertebral compression fracture treated with kyphoplasty and developed cement leakage causing significant neurological injury. In both cases CT scan was the diagnostic tool to identify cause of cement leakage. CT scan exhibited violation of medial pedicle wall causing cement leakage in the spinal canal. Both patients displayed clinical improvement after decompression surgery with or without instrumentation. Retrospectively looking at stored fluoroscopic images, we found that improper position of trocar in AP and lateral view simultaneously while taking entry caused pedicle wall violation. We suggest not to cross medial pedicle wall in AP image throughout the entire procedure and keeping the trocar in the center of pedicle in lateral image would be the most important precaution to prevent such complication. Our case reports adds the neurological complications with kyphoplasty procedure and suggested that along with other precautions described in the literature, entry with trocar along the entire procedure keeping the oval shape of pedicle in mind (under C-arm) will probably help to prevent such complications.
Highlights
Osteoporotic vertebral compression fracture (OVCF) is the commonest complication of osteoporosis[1]
Cement leakage was found from medial pedicle wall of L3 (Figure 1C-E) which was extended along the posterior longitudinal ligament at L2-L4 levels causing severe compression of canal
Epidural cement leakage has only been described for vertebroplasty so far [6], but it has devastating neurological effects in both vertebroplasty[10] and kyphoplasty [26] procedures
Summary
Osteoporotic vertebral compression fracture (OVCF) is the commonest complication of osteoporosis[1]. The purpose of our case report was to present two cases of epidural cement leakage due to pedicle breakage causing significant neurological damage after the kyphoplasty procedure.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have