title: Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine.
abstract: Although extravasations of polymethylmetharylate during percutaneous vertebroplasty are usually of little clinical consequence, surgical decompression is occasionally required if resultant neurologic deficits are severe. Surgical removal of epidural polymethylmetharylate is usually necessary to achieve good neurologic recovery. Because mobilizing the squeezed spinal cord in a compromised canal can cause further deterioration, attempts to remove epidural polymethylmetharylate in the thoracic region need special consideration. A 66-year-old man had incomplete paraparesis and radicular pain on the chest wall after percutaneous vertebroplasty for osteoporotic compression fracture of T7. Radiological studies revealed polymethylmetharylate extravasations into the right lateral aspect of spinal canal that caused marked encroachment of the thecal sac and right neuroforamina. Progressive neurologic deficit and poor responses to medical managements were observed; therefore, surgical decompression was performed 4 months later. After laminectomy and removal of facet joints and T7 pedicle on the affected side, extravasated polymethylmetharylate posterior and anterior to the thecal sac was completely removed without retracting the dura mater. Spinal stability was reconstructed by supplemental spinal instrumentation and intertransverse arthrodesis with banked cancellous allografts. Myelopathy and radicular pain gradually resolved after decompression surgery. The patient was free of sensory abnormality and regained satisfactory ambulation two years after surgical decompression.
authors.affiliation: Department of Orthopedic Surgery, En Chu Kong Memorial Hospital, San-Shia, Taipei County, Taiwan.
authors.forename: Chang-Chin
authors.initials: CC
authors.lastname: Wu
authors.forename: Mu-Hung
authors.initials: MH
authors.lastname: Lin
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Yang
authors.forename: Po-Quang
authors.initials: PQ
authors.lastname: Chen
authors.forename: Tiffany Ting-Fang
authors.initials: TT
authors.lastname: Shih
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000009:adverse effects*; D019299:Decompression, Surgical / Q000379:methods; D004824:Epidural Space / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008297:Male; D010024:Osteoporosis / Q000150:complications; D019904:Polymethyl Methacrylate / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D011843:Radiculopathy / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D012086:Reoperation; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate