Case Report - - Delayed Spinal Cord Compression after Vertebroplasty in Osteoporotic Compression Fracture: A Case Report Jae Keun Oh MD Jun Hyung Cho MD Jun Jae Shin MD Dong Kyu Chin MD and Yong Eun Cho MD Department of Neurosurgery Yongdong Severance Spine Hospital The Spine and Spinal Cord Institute * Yonsei University College of Medicine Seoul Korea Percutaneous vertebroplasty is a popular and minimally invasive procedure with injection of polymethyl methacrylate (PMMA) into a collapsed vertebral body under fluoroscopic guidance Several complications have been reported including leakage into the spinal canal intravascular leakage pulmonary embolism subcutaneous hematoma and infection But most of these complications are happened in the early period after operation We report a rare case of delayed spinal cord compression after vertebroplsty with polymethyl methacrylate cement and it's treatment A 55-year-old female presented with progressive low back pain and radiating pain on both legs for month and suddenly developed paraparesis for day She was already performed percutaneous vertebroplasty 6 months ago due to osteoporotic compression fracture at the first lumbar vertebra (L) During 5 months after vertebropalsty she didn't have any neurologic deterioration or pain but on the serial radiologic examinations after vertebroplasty progressive compression fracture of the previously operated site was seen Magnetic resonance imaging showed a dislodgement of solid PMMA mass compressing spinal cord severely So she was performed the operation that is total laminectomy L and pedicle screw fixation T-T2-L2-L3 and posterolateral fusion After the surgery her symptoms were improved and neurologic deficit was recovered Key Words: Polymethyl methacrylate bone cement Percutaneous vertebroplasty Complication Spinal cord compression (fluoroscopic guiding) (polymethylmethacrylate cement) 736) : 35-720 46-92 : 82-2-209-3390( ) 3393( ) Fax: 82-2-346-9229 E-mail: ydnscho@yumcyonseiackr ) 90% Barr Chiras Deramond Jensen 24 80 570) 3784782) Volume 3 No 2 June 2006
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Barr JD Barr MS Lemley TJ McCann RM: Percutaneous vertebroplasty for pain relief and spinal stabilization Spine 25:923-928 2000 2 Burton AW Rhines LD Mendel E: Vertebroplasty and kyphoplasty: A comprehensive review Neurosurg Focus 8(3) 2005 3 Chen HL Wong CS Ho ST Chang FL Hsu CH Wu CT: A lethal pulmonary embolism during percutaneous vertebroplasty Anesth Analg 95:060-062 2002 4 Chin DK Kim YS Cho YE Shin JJ: Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty Neurosurgery 58: 695-700 2006 5 Chiras J Depriester C Weill A Sola-Martinez MT Deramond H: Percutaneous vertebral surgery Technics and indications J Neuroradiol(Fr) 24:45-49 997 6 Cotten A Dewatre F Cortet B Assaker R Leblond D Duquesnoy B et al: Percutaneous vertebroplasty for osteolytic metastases and myeloma: Effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical followup Radiology 200:525-530 996 7 Deramond H Depriester C Galibert P Le Gars D: Percutaneous vertebroplasty with polymethylmethacrylate Technique indications and results Radiol Clin North Am 36:533-546 998 8 De Wijn JR Slooff TJ and Driessens FC: Characterization of bone cements Acta Orthop Scand 46:38-5 975 9 Jasper LE Deramond H Mathis JM Belkoff SM: The effect of monomer-to-powder ratio on the material properties of Cranioplastic Bone 25(2):27S-29S 999 0 Jensen ME Evans AJ Mathis JM Kallmes DF Cloft HJ Dion JE: Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: Technical aspects AJNR Am J Neuroradiol 8: 897-904 997 Kim SY Seo JB Do KH Lee JS Song KS Lim TH: Cardiac perforation caused y acrylic cement: A rare complication of percutaneous vertebroplasty AJRAmJRoentgenol 85(5):245-247 2005 2 Krause WR Krug W Miller J: Strength of the cement-bone interface Clin Orthop Relate Res 63:290-9982 3LeeJURyuKSParkCKChoYSJiCChoKSetal: Percutaneous Polymethylmethacrylate Vertebroplasty in the Treatment of Osteoporotic Thoracic and Lumbar Vertebral Body Compression Fractures: Outcome of 59 Patients J Korean Neurosurg Soc 30:73-79 200 4 Levine SA Perin LA Hayes D Hayes WS: An evidencebased evaluation of percutaneous vertebroplasty Manag Care 9:56-60 2000 5 Lim TH Brebach GT Renner SM Kim JG Lee RE Andersson GB: Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty Spine 5:27(2):297-302 6 Noh CH Yi JS Lee HJ Yang JH Lee IW Kim MC et al: Effect of percutaneous vertebroplasty with polymethylmethacrylate to osteoporotic spinal compression fractures and bursting fractures J Korean Neurosurg Soc 35:365-37 2004 7 Padovani B Kasriel O Brunner P Peretti-Viton P: Pulmonary embolism caused by acrylic cement: A rare complication of percutaneous vertebroplasty AJNR Am J Neuroradiol 20: 375-377 999 8 Scroop R Eskridge J Britz GW: Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplsty: Case report AJNR Am J Neuroradiol 23:868-870 2002 9 Tsai TT Chen WJ Lai PL Chen LH Niu CC Fu TS et al: Polymethylmethacrylate cement dislodgement following percutaneous vertebroplasty; A case report Spine 5:28(22):E457- Volume 3 No 2 June 2006 5
60 2003 20 Uppin AA Hirsch JA Centenera LV et al: Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis Radiology 226:9-24 2003 2 Yoo KY Jeong SW Yoon W Lee J: Acute respiratory distress syndrome associated with pulmonary cement embolism following percutaneous vertebroplasty with polymethylmethacrylate Spine 29:294-297 2004 6 Kor J Spine