Anterior Spinal Artery Syndrome Following Vertebroplasty

Abstract

In Brief Study Design. Case report. Objective. To report a rare case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty. Summary of Background Data. Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. Here, we describe a severe complication associated with this procedure; a similar complication has not been reported previously. Methods. A 63-year-old woman suffered from persistent severe back pain that radiated to both sides of the chest wall 1 week before medical consultation. Magnetic resonance imaging analysis of the thoracolumbar spine revealed a pathologic fracture in the body of the T9 and T10 vertebrae, with retropulsion into the spinal canal and compression of the spinal cord at the T10 level. We performed decompressive laminectomy of the T9–10 vertebrae with tumor biopsy and vertebroplasty. Results. Immediately after the operation, the patient experienced paraplegia and loss of sensitivity to pain/temperature; however, deep pressure sensation and 2-point discrimination below the umbilicus (T10 level) were preserved. Computed tomography scans showed the presence of PMMA in T9 and T10, with opacification of the paravertebral vessels, the left intercostal artery at the T10 level, and a segment of the anterior spinal artery at the T10–11 level. Conclusion. We present the first report describing a case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty. The severity of this complication warrants that surgeons should inform patients of the same while obtaining their consent for vertebroplasty. The use of vertebroplasty for the treatment of painful metastatic compression fractures has been widely discussed in literature and has been approved by medical professionals. We describe the case of a patient with a metastatic compression fracture at the T9 and T10 levels. The patient developed the anterior cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty.