gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Anterior spinal artery syndrome after cervical vertebroplasty via ventral approach in a 57-year old woman with metastasized breast cancer. Review of the literature and case report

Meeting Abstract

  • Gregory Ehrlich - Neurochirurgische Klinik Universitätsklinikum Mannheim, Mannheim, Deutschland
  • Mirko Arp - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Mannheim, Deutschland
  • Daniel Hänggi - Neurochirurgische Klinik Universitätsklinikum Mannheim, Mannheim, Deutschland
  • Jason Perrin - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • Aldemar Andres Hegewald - Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 088

doi: 10.3205/17dgnc651, urn:nbn:de:0183-17dgnc6517

Published: June 9, 2017

© 2017 Ehrlich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Vertebroplasty and kyphoplasty are minimally invasive techniques for treatment of painful vertebral compression fractures caused by osteoporosis or osteolytic metastasis. These procedures are associated with a low risk profile. But serious complications, like cement leakage with spinal cord compression or vessel embolization, can occur. We describe a case, developing a quadriplegia caused by arterial cement embolism with ischemia of the cervical cord after vertebroplasty.

Methods: A 57-year-old woman with pulmonary and bony metastasized breast cancer suffered from therapy resistant thoracic and neck pain. The CT and MRI scans of the whole spine showed osteolytic metastases of the fifth cervical and the fourth thoracic vertebral body. No compression of the spinal canal was seen. Cervical vertebroplasty via a ventral approach and percutaneous thoracic kyphoplasty was performed.

Results: Immediately after recovery from the anesthesia, the patient experienced a pronounced quadriplegia with loss of pain and temperature sensation below C4; however, deep pressure sensation and two-point discrimination were preserved. The directly initiated CT scan of the spine showed no cement leakage into the spinal canal; but in the thin-layer CT reconstructions of the cervical spine, a paravertebral venous vessel directly discharged into an arterial vessel feeding the anterior spinal artery could be detected. After performing a MRI scan 3 days later, an extensive cervical ischemia of the ventral horn and commissura was shown as the cause of the neurological symptoms.

Conclusion: Despite the simplicity and safety of vertebroplasty and kyphoplasty, this rare case of arterial embolism showed the possibility of grave complications with tremendous consequences for the patients further life.