![]() Decrease of vertebral body bone mineral density after spinal fusion surgery was demonstrated because of biomechanical stresses, postoperative immobilization and mineral metabolism. In our case, osteoporotic compression fracture of instrumented vertebra was considered based on image examination, history of initial lumbar fusion surgery and history of falls. ![]() Instrumented spinal fusion represents the most common surgeries for various spinal disorders however, there have been only three documented case reports of compression vertebral fracture occurring within vertebra existing instrumentation or within the solid vertebral fusion. The plain x-ray and CT scan revealed satisfactory position of the internal fixation but massive leakage of bone cement into the canal at the L5-S1 level, which resulted in significant compression of the S1 nerve root (Fig. Bowel and bladder function remained normal and there were no difficulty evacuating or urinary incontinence. Hyporeflexia of the Achilles tendon was detected on the left side, but pathologic reflexes, superficial reflexes, and the upper limb neurologic examination were unremarkable. Neurologic examination evaluated the muscle strength of left lower extremity as grade 4/5 according to the British Medical Research Council (BMRC) scale. Physical examination revealed tenderness and percussion pain at the paravertebral and spinous processes of L5-S1 without restricted lumbar spine motion. The numerical rating scale (NRS) scores for pain were 8 to 9 at the moment of severe pain. The pain was severe and stabbing, and was aggravated by position changes. The patient was hospitalized at our institution again due to the progression of low back pain with radiation to the left thigh 1 week after PKP surgery. We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from 元–5 4 years prior and had an unremarkable postoperative course. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. ![]() Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures.
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