The Spine Journal 15 (2015) 1493–1494

Intradural cement leakage after vertebroplasty An 87-year-old female patient had back pain with acute deterioration. The patient could walk with no neurologic deficit. Magnetic resonance imaging of the lumbar spine showed the edematous compression fracture of L1 vertebral body with moderate encroachment of canal by the

Fig. 1. Sagittal T2-weighted magnetic resonance imaging of the lumbar spine revealing the collapsed L1 vertebral body (arrow) of high signal intensity, indicative of edema. 1529-9430/Ó 2015 Elsevier Inc. All rights reserved.

retropulsed bone fragment (Fig. 1). Vertebroplasty for L1 was performed under intravenous sedation 4 days later. Complete paralysis of left lower extremity and right leg weakness with little against gravity were observed after the procedure. Emergent computed tomography revealed that polymethyl methacrylate cement leaked into the epidural and intrathecal spaces from T12 to L2 level (Fig. 2). Therefore, emergent laminectomy from T12 to L2 with epidural bone cement removal for decompression was performed. After that, there was no clinical improvement of lower extremity weakness. This patient then received rehabilitation program. At follow-up 2 years after leakage, she still had lower leg weakness and could not walk on her own.

Fig. 2. Sagittal reformatted computed tomography after vertebroplasty showing cement leaking into the epidural (open arrow) and intrathecal (solid arrow) spaces. Note the myelography-like appearance with visualization of nerve roots.


C.-H. Chen et al. / The Spine Journal 15 (2015) 1493–1494

Chia-Hui Chen, PhDa,b Ming-Tsung Chuang, MDc Chien-Kuo Wang, MDc a Department of Medical Imaging and Radiological Sciences Kaohsiung Medical University 100 Tz You 1st Rd Kaohsiung, Taiwan b Department of Ophthalmology Kaohsiung Medical University Chung-Ho Memorial Hospital

100 Tz You 1st Rd Kaohsiung, Taiwan c Department of Radiology National Cheng Kung University Hospital 138 Sheng Li Rd Tainan 70403, Taiwan FDA device/drug status: Not applicable. Author disclosures: C-HC: Nothing to disclose. M-TC: Nothing to disclose. C-KW: Nothing to disclose.

Intradural cement leakage after vertebroplasty.

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