gms | German Medical Science

Objective: Percutaneous vertebroplasty has become more and more popular in the treatment of pain caused by pathological fractures of the spine. Especially in oncological patients with osteolytic metastases the method provides rapid pain relief plus additional stabilization. Severe complications of this procedure have rarely been reported in the literature. Besides massive pulmonary embolism as a major complication the surgeon is still afraid of cement leakage into the spinal canal with subsequent neurological deterioration.

Methods: A well documented case report is presented. A 61-year-old woman suffering from multiple myeloma underwent percutaneous vertebroplasty at the Th12 level. This vertebral body showed a nearly complete osteolytic transformation with a developing pathologic fracture. Even opioids did not result in further pain relief. Total vertebral body replacement with subsequent spondylodesis had been rejected by the patient. Although the vertebral involvement was limited to a single level, we recommended vertebroplasty under general anaesthesia. Because of the thin dorsal wall of Th12 we were afraid of a potential cement leakage with compression of the neural structures. The cement application was performed by mild to moderate pressure under repeated intraoperative x-ray controls. Before removal of the vertebroplasty needles the last control x-ray surprisingly revealed nearly total obliteration of the spinal canal by the bone cement used. Without delay we performed a rapid bilateral interlaminary fenestration at the Th12/L1 level with subsequent removal of the extruded cement. Postoperatively the patient was without neurological compromise and could be routinely discharged.

Results: The immediate intervention protected the patient from the development of a conus medullaris syndrome. Seven months postoperatively the patient is still in good clinical condition and pain-free.

Conclusions: Percutaneous vertebroplasty is an accepted method for the treatment of osteolytic metastases of the spine. The surgeon however must be aware to ensure an intact dorsal wall of the vertebral body involved if cement augmentation is considered. In suspected high-risk cases we recommend vertebroplasty to be performed under general anaesthesia in order to enable rapid surgical intervention in cases of spinal compromise caused by extruded material. If during vertebroplasty spinal cord or cauda compression is suspected, appropriate microsurgical decompression should be performed without further diagnostics.