Cement extravasation during kyphoplasty in an intact posterior wall vertebral fracture: A case report

Introduction: In management of vertebral compression fracture, several minimal invasive procedures have been introduced. Some of them are vertebral augmentation techniques such as vertebroplasty and kyphoplasty. Even though the cement leakage rates are significantly lower than vertebroplasty procedures, intracanal extravasation is also uncommon in kyphoplasty procedure. Case Presentation: A 44-year-old male presented with back pain due to pathological vertebral compression fracture of thoracal 10 came to our institution to be treated with kyphoplasty. During the procedure, the cement leaked into the spinal canal due to disruption of the posterior wall of the vertebral body. As a consequence of the deterioration of the neurological status, an immediate exploration and decompression were performed after CT-Scan results were obtained to identify the location and size of the leak. After decompression, the recovery was significant. However, at the final follow up the neurologic recovery has yet to recover. Discussion: Intracanal cement leakage has devastating neurological effects on both vertebroplasty and kyphoplasty procedure. Careful monitoring during the cement administration was paramount. As there are no current guidelines about the rate of administration and how to measure the volume of the cement needed, the insertion technique should be tailored according to the fracture morphology, the height restored, the viscosity of the cement, and the surgeon himself. Conclusion: Intact posterior wall, the amount of cement, and the injection pressure are the main factors that may contribute to cement leakage during the kyphoplasty procedure. Careful evaluation of these factors must be done pre- and intra-operatively in order to prevent leakage.