Yonsei Med J.  2010 May;51(3):466-468. 10.3349/ymj.2010.51.3.466.

Serious Complication of Cement Augmentation for Damaged Pilot Hole

• Jung MY
• Shin DA
• Hahn IB
• Kim TG
• Huh R
• Chung SS

• KMID: 1075005
• DOI: http://doi.org/10.3349/ymj.2010.51.3.466

Abstract

Polymethl methacrylate (PMMA) screw reinforcement is frequently used in osteoporotic bone as well as in damaged pilot holes. However, PMMA use can be dangerous, since the amount of applied cement is uncontrolled. A 47-year-old male with traumatic cervical spondylolisthesis at C6-7 underwent anterior cervical plate fixation. During repeated drilling and tapping for false trajectory correction, a pilot hole was damaged. Although it was an unconventional method, PMMA augmentation was tried. However, PMMA was accidentally injected to the cervical spinal cord owing to lack of fluoroscopic guidance. The PMMA was surgically removed after corpectomy and durotomy. The patient had left side hemiparesis (Grade 2/5) immediately post operation. The patient improved spontaneously (Grade 4/5) except for 4th and 5th digit extension. Here, we report a rare complication of PMMA extrusion in the spinal cord during a damaged pilot hole injection, which has not previously been described.

Keyword

Bone Cements; complication; polymethyl methacrylate

MeSH Terms

Bone Cements/*adverse effects/therapeutic use
Bone Screws
Cervical Vertebrae/*surgery
Humans
Male
Middle Aged
Polymethyl Methacrylate/adverse effects/therapeutic use

Figure

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  Fig. 1 Intraoperative C-arm image shows two masses at C6. One is located in the intradural-extramedullary space (thin arrow) and the other in the intramedullary space (thick arrow).

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  Fig. 2 Removed particle. Left mass located in the intradural extramedullary space. Right mass located in the intramedullary space.

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  Fig. 3 (A) Postoperative sagittal T2-weighted magnetic resonance image shows high signal intensity at C6. (B) Axial T2-weighted magnetic resonance image shows high signal intensity in the left side of the spinal cord.

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