Background: Percutaneous balloon kyphoplasty is an effective, minimally invasive
procedure that is used to relieve pain and stabilize spine fractures caused by severe
osteoporosis or osteolysis due to tumor metastasis. However, there remains a risk of
bone cement leakage during and after kyphoplasty, especially in cases with severe
vertebral wall destruction or neurological deficits.
Objective: This article presents a case in which kyphoplasty was used to manage
these complications in a woman with vertebral compression fractures caused by tumor
metastasis.
Design: Case report.
Setting: Pain management clinic.
Methods: The patient was a 76-year-old woman who had severe low back pain,
lower extremity weakness, and cauda equina syndrome because of vertebral
compression fracture and spinal metastasis with epidural involvement. The patient
had a large bony defect in the vertebra that the bone filler device could pass freely
through the anterior body wall. Nevertheless, kyphoplasty was successfully performed
by using our new cement injection technique, which is a slow injection of the highly
viscous bone cement, followed by a second injection 10 minutes later to allow the
previously injected cement to harden.
Results: The procedure significantly alleviated all symptoms. The day after the
procedure, in the absence of additional pain medication, the pain had dropped
dramatically to a numerical rating scale 3-4, and there was an improvement in motor
function that allowed the patient to sit and go to the bathroom by herself. In addition,
the voiding sensation had returned, which allowed the patient to defecate and urinate
normally.
Limitations: This report describes a single case report.
Conclusion: Our new cement injection technique may allow balloon kyphoplasty
to be safely and effectively performed in cancer patients with pathological vertebral
compression fractures, even if there are large defects in the anterior vertebral wall and
neurological deficits.
Key words: Compression fractures, kyphoplasty, metastasis, neurological deficits,
osteolysis, polymethylmethacrylate.
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