Vice Chair Rehabilitation Medicine Montefiore Medical Center Rye Brook, New York, United States
Case Diagnosis: 67-year-old female with L2 compression fracture status post kyphoplasty with cement extravasation into the IVC.
Case Description: 67-year-old female presented with low back pain secondary to L2 compression fracture. She had been using an extension-based Thoracolumbar-Sacral-Orthosis and taking tramadol for pain. Afterevaluation, weproceeded with L2 kyphoplasty. During the procedure, while cement was injected into the vertebral body under live fluoroscopic guidance, anterior extravasation of cement from the vertebral body was noted. The injection wasimmediately stopped, and the procedure ended. Immediate post-procedure CT abdomen revealed extravasation of cement into the IVC. Results were discussed with vascular surgery and neurosurgery. Given the patient's lack of symptoms, she was discharged with close follow up. At outpatient vascular surgery follow-up, options discussed included filter, stenting, and open removal. Given the solid nature of cement and procedural risks/benefits, conservative management with anticoagulation and follow up imaging wasadvised.
Discussions: Vascular cement extravasation is a rare potential risk of kyphoplasty with possibility of serious and life-threatening outcomes. Vigilant monitoring with live fluoroscopic imaging during injection of bone cement, observing for indications of extravasation is important in order to minimize complications. While posterior extravasation into the spinal canal has been widely reported in the literature, vascular leakage anteriorly is less discussed. Anterior leakage could cause complications such as emboli or vascular stenosis. Here, cement leakage into the IVC was identified early, and pulmonary emboli were avoided. Utilization of interdisciplinary colleagues including neurosurgery, vascular surgery, and interventional radiology assured a comprehensive evaluation and treatment plan for this patient.
Conclusions: This case highlights a rare instance of cement extravasation into the IVC during lumbar kyphoplasty. Comprehensive management includes early recognition of complications, appropriate post-procedural imaging, and coordination of interdisciplinary care. Interventionalists performing vertebral augmentation must understand the rare butpossible risks and be prepared to manage post-procedural treatment plans.
