Intradural Bone Cement Leakage After Vertebroplasty, An Under-Recognized Potential Catastrophe: A Case Report

Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis, often resulting in vertebral collapse, chronic pain, and increased mortality. Vertebroplasty (VP) is a minimally invasive procedure used to alleviate pain by injecting bone cement into fractured vertebrae. However, bone cement leakage is a frequent complication, typically occurring in the extradural space with minimal clinical symptoms. In contrast, intradural cement leakage is rare but can lead to severe consequences such as neural compression and neurological deficits, necessitating urgent intervention. We present a case of a 70-year-old woman who developed intradural cement leakage after VP for a T12 compression fracture. The patient experienced immediate lower limb weakness, numbness, sensory loss, and urinary/defecation dysfunction following the procedure. MRI revealed posterior cement leakage compressing the spinal cord at the T12 level. She underwent surgical decompression and cement removal at our institution, including posterior fixation from T11 to L1, total laminectomy, and durotomy. Due to intraoperative neurophysiological monitoring, complete removal of intradural cement was not achieved. Postoperatively, the patient showed gradual improvement in lower limb muscle strength and sensory function, with near-complete recovery at one-month follow-up. Consequently, to prevent intradural cement leakage, surgeons must be vigilant about this rare complication and perform precise puncture and cautious cement injection. In cases of catastrophic leakage, prompt cement removal and thorough spinal canal decompression are essential. Preoperative CT imaging is crucial for confirming intradural leakage and planning precise surgery to reduce risks and improve outcomes.