Delayed onset of anterior spinal artery syndrome caused by retropulsed bone fragment after kyphoplasty: Case report and literature review

Interventional Pain Medicine, 2023 · DOI: https://doi.org/10.1016/j.inpm.2023.100264 · Published: January 2, 2023

Spinal Cord Injury Pain Management Musculoskeletal Medicine

Simple Explanation

Kyphoplasty is a procedure used to treat fractures in the spine, particularly those caused by osteoporosis. Sometimes, complications can arise after this procedure, including a rare condition called anterior spinal artery syndrome (ASAS). This syndrome can occur if the artery that supplies blood to the front part of the spinal cord is blocked or has reduced blood flow. This report describes a case where ASAS occurred due to a bone fragment pressing on the spinal cord after kyphoplasty. The study emphasizes the importance of being aware of this potential complication and seeking immediate medical attention if neurological symptoms arise after kyphoplasty.

Study Duration

Not specified

Participants

Single patient case study, 83-year-old male

Evidence Level

Level 4, Case Report and Literature Review

Key Findings

1
A rare case of delayed-onset ASAS occurred nine days after kyphoplasty, caused by retropulsion of a bone fragment from a refractured vertebral body.
2
Imaging showed T2 intramedullary hyperintensity spanning from T7-9 and retropulsion of the bone fragments from a refracture of the T8 vertebral body.
3
The patient was diagnosed with T7 American Spinal Injury Association Impairment Scale (AIS) C incomplete paraplegia secondary to anterior spinal cord ischemia.

Research Summary

This case report describes an 83-year-old male who developed anterior spinal artery syndrome (ASAS) nine days after undergoing kyphoplasty for a T8 vertebral compression fracture. The ASAS was caused by retropulsion of bone fragments from a refracture of the T8 vertebral body. The patient initially presented with severe back pain and underwent kyphoplasty without immediate complications. However, he later developed paraparesis and sensory deficits, leading to the diagnosis of ASAS. The authors highlight the importance of considering mechanical retropulsion of bone fragments as a potential mechanism for ASAS following kyphoplasty, in addition to the more commonly reported cement embolism.

Practical Implications

Increased Awareness

Clinicians should be aware of delayed-onset ASAS as a potential complication of kyphoplasty, even in the absence of immediate post-operative issues.

Prompt Diagnosis

In patients presenting with acute myelopathy following vertebral augmentation, clinicians should consider CT angiography to rule out vascular occlusion and MRI to identify bone fragment retropulsion.

Patient Education

Patients undergoing kyphoplasty should be educated about the signs and symptoms of ASAS and instructed to seek immediate medical attention if they develop new neurological deficits.

Study Limitations

1
Lack of angiogram and CT spine during the initial presentation of ASAS.
2
Inability to definitively rule out cement embolism or fibrocartilaginous embolism without specific imaging or biopsy.
3
Single case report limits generalizability.

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