Kyphoplasty is a medical procedure commonly performed to address spinal fractures, particularly those caused by osteoporosis or cancer. This minimally invasive treatment aims to stabilize fractured vertebrae and reduce associated pain. The procedure involves restoring the height of the damaged vertebral body, which can also help correct spinal deformities.
Understanding Kyphoplasty and Cement Leakage
Kyphoplasty involves inserting a needle through the skin and back muscles into the fractured vertebra, guided by X-ray imaging. A balloon-like device is then inflated to create a cavity within the vertebral body and help restore its original height. After the balloon is deflated and removed, bone cement, typically polymethyl methacrylate (PMMA), is injected into the created space. This cement hardens, stabilizing the vertebra and providing pain relief.
Cement leakage occurs when this bone cement spreads outside the targeted vertebral body. Leakage happens into various surrounding areas, including the adjacent disc space, the spinal canal, or into blood vessels. While some leakage may be asymptomatic, larger amounts or leakage into specific locations cause symptoms and complications. The most common sites for cement leakage in kyphoplasty are perivertebral veins, followed by perivertebral soft tissue and the intervertebral disc.
Recognizing Symptoms of Cement Leakage
Symptoms of cement leakage depend on where the cement travels, sometimes appearing immediately or with a delay. If cement leaks into the spinal canal or near nerve roots, new or worsening back pain occurs. This manifests as radiating pain, similar to sciatica, extending into the legs, accompanied by numbness, tingling, or weakness in the limbs. A severe symptom in this area is bowel or bladder dysfunction, which indicates cauda equina syndrome, a condition requiring immediate medical attention.
When cement enters blood vessels, it migrates to distant sites. If it travels to the lungs, a pulmonary embolism results, causing symptoms like chest pain, shortness of breath, a rapid heart rate, or dizziness. Cement migration to the heart also occurs, leading to cardiac issues such as palpitations or heart failure. Such cardiopulmonary manifestations can be life-threatening.
Leakage into the adjacent disc space causes localized pain or stiffness in the back. If the cement extravasates into soft tissues surrounding the vertebra, individuals experience localized pain or swelling at the injection site. Neurological deficits arise, such as spinal artery syndrome, which presents as leg weakness.
When to Seek Medical Attention
Prompt medical consultation is advised for any new or worsening symptoms following a kyphoplasty procedure. While some soreness at the injection site is expected and resolves within a few weeks, persistent or intensifying pain warrants evaluation. This pain signals issues such as improper cement placement or nerve irritation.
Immediate emergency care is necessary if severe symptoms develop. These include sudden, severe new back pain, increasing leg weakness, significant numbness or tingling, or any changes in bowel or bladder control. Symptoms like chest pain, shortness of breath, or a rapid heart rate prompt urgent medical attention, as these indicate a pulmonary embolism. Early diagnosis and intervention helps manage potential complications effectively.
Potential Complications of Cement Leakage
Unaddressed cement leakage leads to several severe outcomes. Neurological deficits are a concern if cement compresses the spinal cord or nerve roots, resulting in permanent nerve damage or paralysis. The heat generated during cement polymerization or the cement’s inherent cytotoxicity contributes to nerve irritation and damage.
Pulmonary embolism, where cement travels to the lungs, is a life-threatening complication if the obstruction is severe, impacting respiratory function. Cardiac complications, such as cement fragments perforating the heart or causing cardiac embolisms, require prompt management. These cardiac events manifest with symptoms like palpitations or chest pain, even weeks or months after the procedure.
Infection is another potential complication if the leakage creates a pathway for bacteria or affects surrounding tissues. Chronic pain or functional impairment results from ongoing nerve irritation, soft tissue damage, or instability caused by the leakage. Further surgical intervention becomes necessary to remove the leaked cement or decompress affected nerves to alleviate symptoms and prevent long-term disability.