Combined extraforaminal and intradiscal cement leakage following percutaneous vertebroplasty.
METHODS
A case report and review of the literature are presented.


OBJECTIVE
To describe an extremely rare case of combined extraforaminal and intradiscal cement leakage in different vertebral levels following percutaneous vertebroplasty.


BACKGROUND
Cement leaks in vertebroplasty are relatively common but generally not clinically significant. To our knowledge, this is the first report of extraforaminal cement leakage inducing radiculopathy combined with intradiscal cement leakage evoking acute adjacent compression fracture.


METHODS
A 78-year-old woman with L2 and L5 osteoporotic compression fractures received vertebroplasty. Two weeks after surgery, the patient presented severe low back pain radiating to the right thigh, with associated weakness and numbness in the right thigh and lower leg. Roentgenographic images revealed cement leakage into the right extraforamen of L2-L3 as well as leakage into L4-L5 disc with acute adjacent compression fracture of L4.


RESULTS
Surgical intervention was required to relieve discomfort. One-stage posterior approach was performed: right L2-L3 intertransverse process approach with removal of extraforaminal leaked cement and posterior instrumentation from L3-L5 and posterior fusion. The severe low back pain, leg pain, and neurologic deficit associated weakness all improved after surgery.


CONCLUSIONS
Although considered a minimally invasive procedure, percutaneous vertebroplasty with polymethylmethacrylate is not risk free. Intractable neurologic complications can occur if it is not performed by experienced physicians under appropriate indications and cautionary safeguards.
Chen
Jung-Kuei
JK
Department of Orthopaedic Surgery, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, Republic of China. jonycjk@yahoo.com.tw
Lee
Hung-Maan
HM
Shih
Jui-Tien
JT
Hung
Sheng-Tsai
ST
D000368:Aged; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D050815:Fractures, Compression / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007403:Intervertebral Disc; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D009408:Nerve Compression Syndromes / Q000209:etiology*; D010024:Osteoporosis / Q000150:complications / Q000473:pathology; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D011183:Postoperative Complications; D016103:Spinal Fractures / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D013126:Spinal Nerve Roots / Q000473:pathology
D001843:Bone Cements; D019904:Polymethyl Methacrylate