Nogami Ryo, Matsuoka Hidenori, Ohashi So, Narikiyo Michihisa, Nagasaki Hirokazu, Tsuboi Yoshifumi
Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan.
J Spine Surg. 2022 Dec;8(4):491-496. doi: 10.21037/jss-22-60.
Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we describe a case of subarachnoid hemorrhage with delayed paralysis after kyphoplasty and review the literature on similar cases to describe the complications of kyphoplasty and vertebroplasty (VP).
An 80-year-old man underwent percutaneous kyphoplasty at a local hospital an osteoporotic vertebral fracture (OVF) at the T12 and L1 level. On the second day after kyphoplasty for T12 OVF, he developed paralysis of the lower limbs. At his initial visit to our clinic, he had a complete loss of sensation below T11 and complete paralysis of both lower extremities. Thoracolumbar magnetic resonance imaging revealed an intradural hematoma on the ventral side of the spinal cord, in the spinal canal from T5 to T12, compressing the spinal cord. Thoracolumbar computed tomography showed a fracture line in the medial cortex of the right pedicle at T12 and a tract from the spinal canal to the vertebral body. An emergency posterior decompression from T11 to L1 was performed. A small hole was found on the right side of the pedicle at T12, and tear of the nerve and subarachnoid hematoma were observed in the vicinity of the T11 nerve root. The subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. Eventually, he was able to walk and was transferred for rehabilitation.
Percutaneous surgery through the pedicle might cause hematoma and bone cement leakage into the spinal canal. This can be a serious complication: hence prevention is important.
经皮椎体后凸成形术后发生脊髓硬膜内（硬膜下和蛛网膜下）血肿是一种极其罕见的并发症。在本报告中，我们描述了一例椎体后凸成形术后发生蛛网膜下腔出血并伴有延迟性瘫痪的病例，并回顾了类似病例的文献，以描述椎体后凸成形术和椎体成形术（VP）的并发症。
一名80岁男性在当地医院接受了经皮椎体后凸成形术，治疗T12和L1水平的骨质疏松性椎体骨折（OVF）。在对T12 OVF进行椎体后凸成形术后第二天，他出现了下肢瘫痪。在初次就诊于我们诊所时，他T11以下感觉完全丧失，双下肢完全瘫痪。胸腰椎磁共振成像显示脊髓腹侧、T5至T12椎管内有硬膜内血肿，压迫脊髓。胸腰椎计算机断层扫描显示T12右侧椎弓根内侧皮质有骨折线，以及从椎管至椎体的通道。急诊进行了T11至L1的后路减压。发现T12椎弓根右侧有一个小孔，在T11神经根附近观察到神经撕裂和蛛网膜下腔血肿。清除了蛛网膜下腔血肿。术后，神经症状迅速改善。最终，他能够行走，并被转至康复科。
经椎弓根的经皮手术可能导致血肿和骨水泥渗漏至椎管内。这可能是一种严重的并发症：因此预防很重要。
