Abdominal Aortic Injury due to Anterior Cement Extravasation from Percutaneous Kyphoplasty

Vertebral body compression fractures being treated percutaneously with methylmethacrylate injection via Kyphoplasty or Vertebroplasty have recently gained favor. Good early results with minimal complications have been reported. Kyphoplasty in general is noted to have less problems with cement extravasation. This particular case illustrates a patient who had previously been treated successfully with percutaneous Kyphoplasty at T11 and T12. One year late he sustained a new L2 compression fracture with severe pain and underwent percutaneous L2 reduction Kyphoplasty. Intraoperatively, a small spike of cement extravasated anterior to the L2 vertebral body. Live fluoroscopy noted pulsation of the cement spike, coinciding with the patient’s pulse. No drop in blood pressure was noted. The patient had an immediate CT Scan performed noting that the spike of cement entered the adventitia of the abdominal aorta. An immediate left-sided retroperitoneal exploration was done and removal of the hard spike of cement was performed prior to rupture of the abdominal aorta. Post operatively the patient remained neurologically and vascularly intact. This case demonstrates a potential serious complication that has not been previously reported with percutaneous kyphoplasty. Techniques to prevent such complications shall be presented.