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Neurological deficit due to cement extravasation following a vertebral augmentation procedure.

Journal of neurosurgery. Spine (2013-05-07)
Gursukhman S Sidhu, Christopher K Kepler, Katherine E Savage, Benjamin Eachus, Todd J Albert, Alexander R Vaccaro
ABSTRACT

The authors endeavor to highlight the surgical management of severe neurological deficit resulting from cement leakage after percutaneous vertebroplasty and to systematically review the literature on the management of this complication. A patient presented after a vertebroplasty procedure for traumatic injury. A CT scan showed polymethylmethacrylate leakage into the right foramina at T-11 and L-1 and associated central stenosis at L-1. He underwent decompression and fusion for removal of cement and stabilization of the fracture segment. In the authors' systematic review, they searched Medline, Scopus, and Cochrane databases to determine the overall number of reported cases of neurological deficit after cement leakage, and they collected data on symptom onset, clinical presentation, surgical management, and outcome. After surgery, despite neurological recovery postoperatively, the patient developed pneumonia and died 16 days after surgery. The literature review showed 21 cases of cement extravasation with neurological deficit. Ultimately, 15 patients had resolution of the postoperative deficit, 5 had limited change in neurological status, and 2 had no improvement. Cement augmentation procedures are relatively safe, but certain precautions should be taken to avoid such complications including high-resolution biplanar fluoroscopy, considering the use of a local anesthetic, and controlling the location of cement spread in relationship to the posterior vertebral body. Immediate surgical intervention with removal of cement provides good results with complete recovery in most cases.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Poly(methyl methacrylate), average Mw ~120,000 by GPC
Sigma-Aldrich
Poly(methyl methacrylate), average Mw ~350,000 by GPC
Sigma-Aldrich
Poly(methyl methacrylate), average Mw ~15,000 by GPC, powder
Sigma-Aldrich
Poly(methyl methacrylate)
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 2,000
Sigma-Aldrich
Poly(methyl methacrylate), isotactic, >80% isotactic
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 2,480,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 100,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, average Mw 97,000 (Typical), average Mn 46,000 (Typical)
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 20,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 50,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 10,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 4,000
Supelco
Poly(methyl methacrylate), analytical standard, for GPC, 8,000