Serious complication of cement augmentation for damaged pilot hole

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.