Rare Episode of Cement Leakage During Vesselplasty in a Case of Vertebral Compression Fracture

Abstract

Background: Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement.

Case description: A 77-year-old woman presented with debilitating back pain owing to acute T6 compression fracture as detected by magnetic resonance imaging. Under biplanar fluoroscopy, vesselplasty using a polyethylene terephthalate balloon container was performed at the T6 vertebrae. During cement injection, balloon rupture and cement leakage occurred compromising the spinal canal. Emergent laminectomy and cement removal were performed. Paraplegia developed postoperatively.

Conclusions: Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.

Keywords: Cement leakage; Osteoporosis; Paraplegia; Vertebral compression fracture; Vesselplasty.