Anterior spinal artery syndrome following vertebroplasty: a case report.
METHODS
Case report.


OBJECTIVE
To report a rare case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty.


BACKGROUND
Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. Here, we describe a severe complication associated with this procedure; a similar complication has not been reported previously.


METHODS
A 63-year-old woman suffered from persistent severe back pain that radiated to both sides of the chest wall 1 week before medical consultation. Magnetic resonance imaging analysis of the thoracolumbar spine revealed a pathologic fracture in the body of the T9 and T10 vertebrae, with retropulsion into the spinal canal and compression of the spinal cord at the T10 level. We performed decompressive laminectomy of the T9-10 vertebrae with tumor biopsy and vertebroplasty.


RESULTS
Immediately after the operation, the patient experienced paraplegia and loss of sensitivity to pain/temperature; however, deep pressure sensation and 2-point discrimination below the umbilicus (T10 level) were preserved. Computed tomography scans showed the presence of PMMA in T9 and T10, with opacification of the paravertebral vessels, the left intercostal artery at the T10 level, and a segment of the anterior spinal artery at the T10-11 level.


CONCLUSIONS
We present the first report describing a case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty. The severity of this complication warrants that surgeons should inform patients of the same while obtaining their consent for vertebroplasty.
Tsai
Yu-Duan
YD
Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Liliang
Po-Chau
PC
Chen
Han-Jung
HJ
Lu
Kang
K
Liang
Cheng-Loong
CL
Wang
Kuo-Wei
KW
D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001416:Back Pain / Q000209:etiology / Q000601:surgery; D001843:Bone Cements / Q000009:adverse effects*; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D017288:Pain Threshold; D010264:Paraplegia / Q000209:etiology; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D013116:Spinal Cord / Q000098:blood supply*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D013577:Syndrome; D013697:Thermosensing; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000009:adverse effects*
D001843:Bone Cements; D019904:Polymethyl Methacrylate