Symptomatic epidural cement leakage after percutaneous vertebroplasty: A case report of successful management by surgical excision with literature review
| Autor: | Hitesh N. Modi, Udit Patel, Nagesh Bhandari, Utsab Shrestha |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Leak Decompression medicine.medical_treatment macromolecular substances neurologic deficit Percutaneous vertebroplasty urgent ct scan medicine Orthopedics and Sports Medicine Spinal canal Orthopedic surgery business.industry Vertebral compression fracture technology industry and agriculture Laminectomy medicine.disease Surgery medicine.anatomical_structure epidural cement leak vertebroplasty Surgical excision Neurology (clinical) business RD701-811 Cement leakage removal of cement |
| Zdroj: | Indian Spine Journal, Vol 4, Iss 2, Pp 243-249 (2021) |
| ISSN: | 2589-5087 2589-5079 |
| Popis: | The purpose of this case report was to present successfully treated case of symptomatic cement leakage after percutaneous vertebroplasty procedure (PVP) with technical tips to avoid such injury and to present literature review. PVP is a simple solution to treat osteoporotic vertebral compression fracture (OVCF) if it is performed with right indications. Cement leak into spinal canal during PVP can lead to catastrophic accident and cause severe neurological deficit that requires an urgent exploration and removal of cement. To avoid medial pedicle breach, there should be a definitive guideline during PVP. An 81-year-old lady had PVP after injury for OVCF at D12. She developed severe neurological deficit immediately after the procedure; however, she was managed conservatively. On presentation to us, urgent investigations with CT scan revealed cement leak into spinal canal from medial pedicle breach extending from D10-12 level with severe cord compression. Her surgery was performed with wide laminectomy at D10-D12 levels with transpedicular stabilization D9-L2 along with neuromonitoring. Cement mass was isolated from the dura and removed achieving decompression of the cord. Postoperatively, patient showed significant neurological improvement and walked independently with the help of stick in three months. In conclusion, although PVP is a convenient solution for painful OVCF, care must be taken while considering this option such as timing, insertion of needle, viscosity of cement, and C-arm monitoring. If neurological deficit occurs, urgent CT scan for the diagnosis and exploration with removal of cement with or without stabilization is mandatory. |
| Databáze: | OpenAIRE |
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