title: Anterior spinal artery syndrome after percutaneous vertebroplasty.
abstract: BACKGROUND
  Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. We describe a severe complication associated with this procedure; only one previous case has been reported in the literature.
  
  
  OBJECTIVE
  To report a case of anterior spinal cord syndrome caused by a direct cement leakage in the arterial vessels after vertebroplasty.
  
  
  METHODS
  A 20-year-old man who has been diagnosed with multifocal Ewing sarcoma for 5 months suffered from severe and chronic inflammatory polyarthralgia in the left knee, pelvis, and the low back. The imaging studies, X-ray and computed tomography scan, showed the presence of pathologic fractures of T8 and L1 vertebrae. There was no retropulsion of bony fragment in the vertebral canal. A percutaneous vertebroplasty of T8 and L1 level was performed.
  
  
  RESULTS
  Immediately after the procedure, the patient experienced a total paralysis and loss of sensitivity to pain and temperature in both lower limbs; however, deep pressure sensation and two-point discrimination below the umbilicus were preserved. Computed tomography scans showed no leakage of polymethylmethacrylate of T8 and L1 vertebral bodies, with opacification of the right intercostal artery at the L1 level and a segment of the anterior spinal artery at the T10-L1 level.
  
  
  CONCLUSIONS
  Although percutaneous vertebroplasty has many benefits, including its simplicity and relative safety, it could lead to serious complications. The current case demonstrates the direct leakage of cement within the anterior spinal artery leading to an irreversible paralysis. The clinicians should be aware of such complications to happen and explain it to their patients.
authors.affiliation: Department of Orthopedic Surgery, Hotel Dieu de France University Hospital, Achrafiye, Alfred naccach St, Beirut, Lebanon. paul.yazbeck@hotmail.com
authors.forename: Paul G
authors.initials: PG
authors.lastname: Yazbeck
authors.forename: Rana B
authors.initials: RB
authors.lastname: Al Rouhban
authors.forename: Sami G
authors.initials: SG
authors.lastname: Slaba
authors.forename: Gaby E
authors.initials: GE
authors.lastname: Kreichati
authors.forename: Khalil E
authors.initials: KE
authors.lastname: Kharrat
mesh_terms: D020759:Anterior Spinal Artery Syndrome / Q000139:chemically induced*; D001843:Bone Cements / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010243:Paralysis / Q000209:etiology; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D012512:Sarcoma, Ewing / Q000150:complications; D016103:Spinal Fractures / Q000601:surgery; D054854:Vertebroplasty / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate