Abstract
Introduction
Cement extravasation (CE) during vertebroplasty or kyphoplasty for vertebral compression fracture (VCF) is not uncommon, though neurological deficits occur rarely and when paraparesis occurs severe cord compression has been described. We report a case of progressive paraparesis in the setting of non-compressive extradural CE during kyphoplasty with evidence for spinal artery syndrome and neurological recovery after treatment.
Case presentation
A 77-year-old female with T12 VCF failed conservative treatment and underwent kyphoplasty. In the recovery room, the patient was noted to have bilateral leg weakness, left worse than right, and had urgent CT scan that showed right paracentral CE without cord compression or arterial cement embolization. The patient was transferred to a tertiary hospital and had MRI of the spine that confirmed extradural CE and no cord compression. Because the patient had progression of lower extremity deficits despite medical management, she underwent surgical decompression, cement excision, and spinal fusion with instrumentation. Post op MRI showed T2 hyperintensities in the spinal cord consistent with spinal artery syndrome. One month post op, she had almost complete recovery of her neurological function.
Discussion
Spinal artery syndrome may be considered in patients with neurological deficit s/p kyphoplasty even if the extravasated cement does not compress the spinal cord and even if the deficits are worse contralateral to the cement extravasation. If spinal artery syndrome is present and medical management does not improve the deficits, surgery may be indicated even if there is no cord compression.
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Data availability
All data from the above case report that was generated can be found within the article. Please contact the corresponding author with questions regarding any of the data included and/or details of the reported case.
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The authors would like to thank the patient and her family for generously allowing us to present this case.
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Primary manuscript drafting was carried out by BMS and BCG. Manuscript editing as well as concept review/generation was a group task split equally among all authors. Direct care of the patient involved was provided by CZ and senior author, SK.
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Striano, B.M., Goh, B.C., Ziino, C. et al. Spinal artery syndrome following kyphoplasty in the setting of a non-compressive extradural cement extravasation: a case report. Spinal Cord Ser Cases 9, 18 (2023). https://doi.org/10.1038/s41394-023-00574-6
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DOI: https://doi.org/10.1038/s41394-023-00574-6
