Compression fracture in the middle of a chronic instrumented fusion that developed into pseudarthrosis after balloon kyphoplasty

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report

BACKGROUND

Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality.

CASE PRESENTATION

We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up.

CONCLUSIONS

We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

Treatment of a Compression Fracture at a Previously Instrumented Lumbar Vertebral Body Using Balloon Kyphoplasty: A Technical Case Report

Compression fractures are common among osteoporotic patients and can be a significant source of pain and disability. Patients who suffer a compression fracture at an instrumented level of a lumbar fusion are most often treated conservatively. Herein, we demonstrate a safe and effective treatment for a vertebral compression fracture (VCF) at a previous level with instrumented fusion and pedicle screw fixation. An 89-year-old female with a history of multiple osteoporotic compression fractures treated with previous kyphoplasties and a prior instrumented fusion at L4-L5 presented with debilitating lower back pain for one week. After failing conservative management, computed tomography (CT) and magnetic resonance imaging (MRI) study of the lumbar spine revealed an acute VCF of the previously instrumented L5 vertebral body. Under biplanar fluoroscopy, a balloon kyphoplasty was performed at the L5 vertebrae utilizing the Inflatable Vertebral Augmentation System (IVAS) from Stryker® (Kalamazoo, MI, USA). We were able to demonstrate that the treatment of an acute VCF with balloon kyphoplasty is feasible in patients who have a history of previous instrumentation with pedicle screws remaining at the fracture level.