Intradural cement leakage: a rare complication of percutaneous vertebroplasty

Summary

Percutaneous vertebroplasty (PV) is one of the alternative treatments for vertebral fractures. Reported significant complications include pain, radiculopathy, spinal cord compression, pulmonary embolism, infection and rib fractures. In this report, we highlight intradural cement leakage which is a rare complication of the procedure.

A 49 year old man with a T12 compression fracture due to multiple myeloma was referred to the neurosurgery department from the orthopaedics and traumatology clinic after developing a right lower limb weakness following percutaneous vertebroplasty with polymethylmethacrylate. An urgent thoraco-lumbar magnetic resonance imaging was performed. The T1 and T2-weighted images demonstrated intradural extramedullary and epidural cement leakages which were hypointense on both sequences. Total laminectomy was performed at T12 and L1 and two epidural cement collections were excised on the right. Then, a dural incision from T12 to the body of L1 was done and cement material seen in front of the rootlets excised without any nerve injury. The patient was discharged after a week and referred to the haematology clinic for additional therapy of multiple myeloma. Although the cement leakage was extensive, the right leg weakness improved significantly and he began to walk with assistance 3 months later.

Good quality image monitoring and clear visualisation of cement are essential requirements for PV using polymethylmethacrylate to prevent this complication from the treatment.