Anesth Pain Med.  2018 Jan;13(1):93-97. 10.17085/apm.2018.13.1.93.

Therapy of thermal injury due to bone cement leakage by cooled normal saline irrigation through epidural catheterization: A case report

• Hong SW
• Jung H
• Kwak KH
• Yang J
• Kim HJ
• Park JM

• KMID: 2436062
• DOI: http://doi.org/10.17085/apm.2018.13.1.93

Abstract

A 72-year-old woman was diagnosed with Kümmell's disease of the T12 and L3 vertebrae. During bone cement injection under continuous fluoroscopic guidance, bone cement spread beyond the posterior border of the T12 vertebral body. We halted the injection immediately. A few minutes later, the patient complained of increasing right lower quadrant abdominal pain. This was diagnosed as a preceding sign of neurological complication due to thermal injury. Consequently, we administered an epidural steroid injection, followed by cooled normal saline irrigation through an epidural catheter to minimize and treat the thermal injury. The pain gradually decreased after saline irrigation and completely disappeared after approximately 10 minutes. After completing the percutaneous vertebroplasty, the patient's lower back pain improved without neurological complications. In conclusion, immediate epidural steroid injection followed by cooled normal saline irrigation through epidural catheterization can be used to treat thermal injury due to bone cement leakage.

Keyword

Bone cement; Epidural; Injury; Polymethyl methacrylate; Vertebroplasty

MeSH Terms

Abdominal Pain
Aged
Catheterization*
Catheters*
Female
Humans
Low Back Pain
Polymethyl Methacrylate
Spine
Vertebroplasty
Polymethyl Methacrylate

Figure

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  Fig. 1 Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine. CT and MRI of the lumbar spine shows compression fractures with signs of intravertebral vacuum phenomena, which are characteristic features of Kümmell’s disease, at T12 and L3 (arrows).

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  Fig. 2 C-arm fluoroscopic images. Bone cement spreads slightly beyond the posterior border of the T12 vertebral body (arrow).

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  Fig. 3 Epidural steroid injection by interlaminar approach. C-arm fluoroscopic image shows dispersed radiolucent dye in the posterior epidural space (arrow).

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  Fig. 4 Computed tomography (CT) image after percutaneous vertebroplasty. CT shows large amount of bone cement leaked into the spinal canal.

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