Case Report | DOI: https://doi.org/10.31579/2768-2757/038
1Neurosurgery department, Urumia University of medical sciences.
2Neurosurgery department, Tabriz University of medical sciences.
3Neurosurgery department, Tabriz University of medical sciences.
4Student research committee, Arak University of medical sciences.
*Corresponding Author: Amir Kamalifar, Neurosurgery department, Urumia University of medical sciences.
Citation: A Kamalifa, F Salehpour, F Mirzaii, S Kamalifar. (2022). Delay Onset Radicular Pain Due to Vertebroplasty Cement Leakage. Journal of Clinical Surgery and Research. 3(2); DOI: 10.31579/2768-2757/038
Copyright: ©2022 Amir Kamalifar, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 06 December 2021 | Accepted: 31 December 2021 | Published: 10 January 2022
Keywords: vertebroplasty; cement leakage; neurological deficit
Neurological deficit due to Vertebroplasty cement leakage as an important complications with early sign and symptom but delay radicular pain and muscle weakness presentation was rare and need correct diagnostic approach.
Vertebroplasty as an invasive pain reliving procedure in spinal painful osteoporotic fracture ,neurological deficit due to cement leakage less common but serious problem, neurological deficit mostly diagnosis in time of surgery [1] but we can’t find any report of delay neurological deficit due to vertebroplasty cement leakage we report our patient compliant and our approach to him.
76 years old man visited with sever back pain an evaluated for pain and candidate for vertebroplasty cement injection procedure , no radicular pain and no evidence of root or other neurological involvement , procedure was done under local anesthesia and C- arm fluoroscopy guide in prone position by unilateral transpedicular approach , at the time of surgery patient we can’t find any evidence of cement leakage, patient Paine improve significantly and discharged without any neurological deficit, after 2 month patient return with sever radicular leg pain in left foot and evidence of muscle weakness lower than 4/5 in left foot future MRI showed evidence of root compression in level of L3 look like foreign body other than intervertebral disk , patient go under Ct spiral with thin cut in axial and sagittal reconstruction project showed hyper density particle in spinal canal and foramen( figure 1 ) , density of particle look like vertebroplasty cement density , patient go under standard laminectomy and leakaged cement particle was removed from foramen and spinal canal , patient pain relived rapidly after surgery and muscle strong was improved after 4 month rehabilitation care.
Prior vertebroplasty was done by French radiologist for vertebral hemangioma, after that vertbroplasty was done in many disease but in last decade vertebroplasty turn to main procedure in treatment of painful osteoporotic fracture specially not response to conservative treatment [2], Reported complications of Vertebroplasty include infection, bleeding, transient radiculopathy, spinal stenosis, and pulmonary embolization, cement leakage estimate 30% but neurological deficit was rare( less than 1%) and many of them was diagnosis at the time of procedure [3], delay presentation very rare , but when we diagnosed of leakage additional procedure like open surgery should be considered . golden time of surgery not clearly but many author emphasis on as soon as possible decompression and remove of cement [4], in this specific case patient return with radicular leg pain and muscle weakness after 3 month however open surgery was done and outcome of patient satisfied the surgery team and patient weakness and pain relived completely, correct needle tip location and cement viscosity have major roll in prevent of leakage, experience of surgeon should not be ignored.
Neurological deficit due to vertebroplasty cement leakage rare but seriouse and immediate decompression can improve the prognosis.
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