title: Insufficient Penetration of Bone Cement Into the Trabecular Bone: A Potential Risk for Delayed Bone Cement Displacement After Kyphoplasty?
abstract: OBJECTIVE
  Balloon kyphoplasty is a minimally invasive procedure used in the treatment of vertebral compression fractures. Although cement leakage is a well-known complication of the procedure, delayed displacement of the injected bone cement material, occurring several weeks after kyphoplasty, is a rare occurrence. In this report, we describe a case of delayed dislodgement of the bone cement occurring 4 weeks after successful kyphoplasty for an osteoporotic compression fracture of L4.
  
  
  METHODS
  A balloon kyphoplasty was successfully performed for the clinical management of an osteoporotic compression fracture of the L4 vertebral body in a 74-year-old patient with Kummel disease. However, further progression of the collapse of L4 vertebra was identified on radiographic imaging obtained 4 weeks after the kyphoplasty. A cystic filling pattern of the bone cement was observed, rather than the expected matrix-like pattern, which contributed to the continued progression of the collapse of the vertebral body.
  
  
  CONCLUSIONS
  As delayed displacement of bone cement can result in progression of an osteoporotic compression fracture of the vertebrae, we propose that sufficient penetration of bone cement into the microstructure of the trabecular bone of the vertebral body during kyphoplasty could reduce the risk of this phenomenon.
authors.affiliation: From the *Zeropain Clinic, Seoul; and †Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yeong Ho
authors.initials: YH
authors.lastname: Jeong
authors.forename: Chul Joong
authors.initials: CJ
authors.lastname: Lee
authors.forename: Jei Taick
authors.initials: JT
authors.lastname: Yeon
authors.forename: Junyeal
authors.initials: J
authors.lastname: Bae
authors.forename: Eunjoo
authors.initials: E
authors.lastname: Choi
authors.forename: Pyung Bok
authors.initials: PB
authors.lastname: Lee
authors.forename: Francis Sahngun
authors.initials: FS
authors.lastname: Nahm
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000009:adverse effects* / Q000627:therapeutic use*; D000071556:Cancellous Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects* / Q000379:methods; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements