title: [A rare complication of kyphoplasty is PMMA-cement loosening - case report and literature review].
abstract: BACKGROUND
  For vertebral body fractures combined with strong back pain, the kyphoplasty is an established method for pain reduction. A balloon effects an excavation in the vertebral body, which will be filled up with cement. We distinguish between cements of polymethyl metacrylate (PMMA) and calcium phosphate. Their diverse chemical qualities enable different indications.
  
  
  METHODS
  A 72-year-old male patient with refractory back pain after a lumbar vertebral body fracture was treated with a kyphoplasty operation. After four days the patient went home with clearly less pain. After two months the patient had a bagatelle trauma at home, which caused an exacerbation of the back pain. In computered tomography we saw a disruption of the PMMA cement plombage forwards and also a kyphosis of the lumbar vertebrae. Therefore we had to operate on the patient two more times. The first time we stabilised the spine from dorsal via an internal fixator. The additive ventral fixation was at that time declined by the patient. Because of the persistency of the back pain after operation combined with a sense of instability, we were ten days after the first revision allowed to stabilise the patient from ventrally with a Harms cage. At the first-year follow-up the patient was still free of pain.
  
  
  CONCLUSIONS
  Injuries of the vertebral body frame cannot be operated exclusively with kyphoplasty. The reason for this is the instability of the vertebral body despite the injection of the PMMA cement. We advise to stabilise the spine in such cases with a dorsal internal fixator additively.
authors.affiliation: Klinik für Unfall- und Orthopädische Chirurgie, Klinikum Nürnberg.
authors.forename: M
authors.initials: M
authors.lastname: Nüchterlein
authors.forename: H J
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D058498:Kyphoplasty / Q000009:adverse effects* / Q000379:methods; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D019904:Polymethyl Methacrylate / Q000009:adverse effects* / Q000627:therapeutic use; D011859:Radiography; D012086:Reoperation; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate