cement leaks

Cement leaks

• Cement leaks toward epidural veins, epidural space and neural foramina : the major complication during acrylic glue injection is epidural overflow of methyl methacrylate with spinal cord compression : this risk is minimized by monitoring the bone filling with a high-quality fluoroscopy unit, and by adequate radiopacity (tantalum) of acrylic glue. Radiculopathy is the major risk with neural foramina leaks. In our series, three complications occurred immediately after cementoplasty with the filling of an epidural vein and neural foramina causing intercostal neuralgia. This complication can be successfully treated by a series of intercostal steroid infiltrations. In case of severe complication, orthopedic or neurosurgical support should be available. Epidural vein filling does not systematically cause neuralgia. In our whole series we never had a dramatic complication such as spinal cord compression due to cement leaks but such cases have been described. It is possible and must absolutely be avoided by an appropriate technique.
• Cement leaks towards the disk. These leaks are usually without clinical consequence, however these leaks may increase the risk of adjacent vertebrae collapse.
• Leak into perivertebral veins can lead to pulmonary cement embolism. In our series, an asymptomatic pulmonary embolism was detected in two cases. In both cases, paravertebral venous opacification was observed. To avoid major pulmonary infarction, the glue should be injected slowly during its pasty polymerization phase under fluoroscopy control, and the injection should immediately be stopped if a venous leak is observed.
• Cement leaks into paravertebral soft tissues have no clinical significance.
• In one case, the control CT scan showed a leak of acrylic cement into an intercostal artery. This leak was asymptomatic.

Figure 14a.   Axial plane, leaks.

Figure 14b.   sagittal plane, leaks.