Root and spinal cord compression from methylmethacrylate vertebroplasty.
METHODS
Case report and literature review.


OBJECTIVE
Clinicians use methylmethacrylate vertebroplasty to treat vertebral hemangiomas, metastases, and osteoporotic fractures. Cement may leak out of the vertebral body and compress the adjacent spinal cord and nerve roots. We review a case of nerve-root and cord compression from methylmethacrylate extrusion during vertebroplasty.


BACKGROUND
A 50-year-old female presented with disabling thoracic back pain. A metastasis to T1 was discovered, with collapse of the vertebral body but without cord compression. Methylmethacrylate vertebroplasty was performed. After injection, portable computed tomography (CT) showed a leakage of methylmethacrylate into the C8 and T1 foramina and spinal canal. Radiculopathy and myelopathy developed. Surgical decompression using the anterior approach was necessary.


METHODS
Case report.


RESULTS
Early surgical intervention decompressed the neural elements and relieved the neurological deficits.


CONCLUSIONS
Neurologic complications of methylmethacrylate vertebroplasty necessitate active involvement of spine surgeons in patient evaluation and management.
Ratliff
J
J
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD 20892, USA. jratliff@box-j.nih.gov
Nguyen
T
T
Heiss
J
J
D001416:Back Pain / Q000601:surgery; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020366:Methylmethacrylate / Q000009:adverse effects*; D008875:Middle Aged; D019637:Orthopedic Procedures; D019736:Prostheses and Implants / Q000009:adverse effects*; D011843:Radiculopathy / Q000209:etiology; D013117:Spinal Cord Compression / Q000209:etiology*; D013118:Spinal Cord Diseases / Q000209:etiology; D013125:Spinal Neoplasms / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D014665:Vasodilator Agents / Q000009:adverse effects*
D001843:Bone Cements; D014665:Vasodilator Agents; D020366:Methylmethacrylate