Rare Complication of Percutaneous Technique: Intradural Cement Leakage and Its Surgical Treatment

Abstract

Popularity of percutaneous vertebroplasty and vertebral augmentation to treat vertebral compression fractures is increasing. Cement leakages are relatively common, but intradural cement leakage is rare. Few cases of intradural cement leakage have been reported in the literature, and emergency surgery has been reported to be <1%. A 64-year-old man with osteolytic vertebral compression fracture at L1, caused by a malignant tumor, had undergone a vertebral augmentation by craniocaudal procedure. Neurologic examination after the surgery revealed paralysis in both legs immediately postoperatively. Computed tomographic imaging revealed a large cement leakage into the spinal canal. The patient was referred to our department for emergency management. He was rapidly scheduled for surgical decompression by laminectomy. First, stabilization by a secure posterior short fixation was done. The laminectomy showed that insertion of a needle through the pedicle had breached the dura and had caused intradural cement leakage. As shown in the Supplementary Video, the piece of intradural cement was finally removed after posterior durotomy. This case demonstrates that even if percutaneous vertebroplasty is a relatively safe technique, it should be performed by well-trained physicians and with great care to prevent disabling complications.

Keywords: Cement leakage; Complication; Intradural; Spinal surgery; Vertebroplasty.