[Extravertebral cement drainage with occlusion of the extradural venous plexus into the vena cava after vertebrobplasty. Case report and review of the literature].
This paper presents the case report of an 88 year old female who came to hospital suffering from a severe lower back pain. Ten days before, she had undergone a vertebroplasty with injection of cement into lumbar vertebra 3 because of an osteoporotic fracture. This treatment did not result in a reduction of the lower back pain, which was the main reason for the procedure. However, the patient claimed to have increasing pain radiating to her left leg. Furthermore, she suffered from numbness of her left leg. Clinical examination showed a lack of power in this leg according to hip flexion with a degree of 3/5. X-ray examinations showed paravertebral cement particles and led to the suspicion that the paravertebral cement had caused nerve root compression. MRI and CT myelography showed that the cement had drained into the intraspinal, extradural venous plexus (Batson's plexus). The plexus was filled out with cement between L2 and L5 on both sides. There was nearly no cement in the fractured vertebra L3, but cement had also run onto the paravertebral veins up to the vena cava, which was also involved. The cemented veins had led to a stenosis of the neuroforamina L2 and L3 on the left side. The result was compression of left L3 nerve root. After consulting with our vascular surgeons, we decided on a non-operative treatment. We prescribed a lumbar brace as external stabilisation and as an antithrombotic treatment we gave the patient weight adapted low molecular weight heparin.
Prymka
M
M
Orthopädische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel. drprymka@hotmail.com
Pühler
T
T
Hirt
S
S
Ulrich
H-W
HW
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects* / Q000627:therapeutic use; D003952:Diagnostic Imaging; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis*; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis*; D011843:Radiculopathy / Q000175:diagnosis*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000187:drug effects*
D001843:Bone Cements