Disclosures: Lauren A. White, DO, MPH: Nothing to disclose

Case Description: The patient presented to the emergency room for insidious back pain; imaging showed T5 lytic lesion with pathologic fracture. No neurologic deficits at presentation, and he was treated conservatively. T5 vertebral biopsy confirmed metastatic lung adenocarcinoma and he was discharged with outpatient follow up. He returned for intractable pain in the same area and underwent T5 radiofrequency tumor ablation and kyphoplasty. Small amount of cement extrusion noted from the posterior aspect of the vertebral body during the procedure. Post-op, he was neurologically intact, but developed worsening lower extremity weakness and sensory loss 48 hours later. Imaging showed cement extrusion into the central canal and neural foramen causing mass effect on the spinal cord and nerve roots. He underwent emergent T4-5 laminectomy and cement evacuation. Exam showed T5 AIS B incomplete paraplegia. He was also treated with corticosteroid taper and palliative radiation therapy. Post-op course notable for bowel incontinence, urinary retention, and multiple pressure injuries. He was transferred to inpatient rehabilitation (IPR) shortly after surgery. Despite initial progress, transfers and mobility were limited by poor trunk control and impaired sensation. He was discharged to subacute rehabilitation.

Setting: Tertiary care hospital

Patient: A 78-year-old male with recently diagnosed lung adenocarcinoma with bony metastases.

Assessment/Results: Patient had several readmissions for morbidities related to his spinal cord injury including infected pressure injury and pulmonary embolism. His functional status continued to decline despite continued subacute rehabilitation. Repeat imaging showed advancing metastases and he was ultimately discharged to hospice.

Discussion: Kyphoplasty is generally a well-tolerated procedure, and patients report successful pain relief. Cement extrusion is a known and accepted risk during vertebral kyphoplasty, however there are few reported cases of resultant spinal cord injury.

Conclusion: While rare, cement extrusion during kyphoplasty can cause permanent spinal cord injury despite cement evacuation and decompression.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/evolving-spinal-cord-injury-due-to-cement-extrusion-during-vertebral-kyphoplasty-a-case-report/