The technique of percutaneous vertebroplasty was developed by Galibert et al.1 to manage refractory vertebral-body compression fractures secondary to osteoporosis. It involves injection of polymethylmethacrylate into the collapsed vertebral body in order to augment the deficient bone and to relieve pain. It also requires placement of a large-bore (10-gauge) spinal needle under fluoroscopic guidance into each affected vertebral body through a posterior bilateral transpedicular approach2.
Vertebroplasty has been performed for approximately 200 patients with osteoporotic vertebral collapse2-10, but not a single instance of spinal-cord compromise or major extrusion of polymethylmethacrylate into the spinal canal has been described. I am aware of only one instance in which a peripheral neuropathy was attributed to the leakage of cement into a neural foramen, and this transient complication resolved spontaneously3.
The current case report documents the catastrophic extrusion of polymethylmethacrylate, both into the spinal canal and into neural foramina at multiple levels of the thoracolumbar spine, following vertebroplasty in an osteoporotic patient.
A sixty-six-year-old woman with multilevel vertebral osteopenia and recent spontaneous compression fractures of the tenth and eleventh thoracic and first lumbar vertebral bodies presented to a local neurosurgeon because of intractable pain, which had been unrelieved by nonoperative care over a three-month period (Fig. 1). The findings on neurological examination were normal.
Fig. 1:
Lateral radiograph of the thoracolumbar spine, made preoperatively, reveals prominent osteopenia with compression fractures of the tenth and eleventh thoracic and first lumbar vertebral bodies.
In September 1999, a percutaneous vertebroplasty was performed with the patient under general endotracheal anesthesia and positioned prone on a Jackson spinal frame. Barium-impregnated polymethylmethacrylate was injected through a 10-gauge needle, which was initially positioned in the posterior aspect of each vertebral body over a Kirschner wire and was inserted through a unilateral transpedicular approach …
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