Percutaneous vertebroplasty has become a mainstay for osteoporotic vertebral compression fractures, which occur when weakened, porous vertebrae collapse under ordinary loads. The procedure offers rapid pain relief, minimal invasiveness, and a short recovery, which explains its popularity among elderly patients who often tolerate major surgery poorly. Yet cement leakage is its most frequent adverse event, with reported incidence reaching as high as 54.7 percent. Most leaks cause no symptoms at all, slipping silently into veins or tissues around the vertebra. When cement escapes into the spinal canal, however, the consequences can be severe: the hardened material can mechanically compress the spinal cord, the heat released as it polymerizes can injure neural tissue, and the mass can trigger secondary ischemia by choking off local blood supply.

In this case, the patient’s own risk profile stacked the odds against her. Quantitative computed tomography measured her average vertebral bone mineral density at 37.6 milligrams per cubic centimeter, far below the diagnostic threshold of 80, confirming severe osteoporosis. Her medical history read like a cardiology textbook: grade 3 hypertension at high cardiovascular risk, coronary artery disease complicated by premature atrial contractions, atrial tachycardia, and complete right bundle branch block, plus deep vein thrombosis in both calves managed with an inferior vena cava filter. She also carried old rib fractures, a hiatal hernia, scoliosis, thoracic spinal stenosis, and a neurogenic bladder. Each condition raised the stakes of any operation, and together they transformed a technically straightforward revision into a high-wire act requiring ten different specialties at the table.

The diagnostic journey began with a careful exclusion process. Because the patient had a history of old cerebral infarction, clinicians first had to rule out acute ischemic stroke as the cause of her worsening leg weakness. Brain MRI showed no new ischemic lesions, and her pre-existing lumbar spinal stenosis had not progressed. The decisive evidence came from thoracic CT, which revealed bone cement leaking into the spinal canal at the T10 level from the left posterior aspect of the vertebral body, compressing the dural sac and nerve roots. Physical examination painted a grim picture: muscle strength graded at only 2 out of 5 on the Medical Research Council scale in both legs, hypoesthesia across the lower limbs and perineum, brisk knee and ankle reflexes, and an overdistended bladder with no urinary sensation even under compression, all hallmarks of thoracic spinal cord compression.

Once the diagnosis was secured, a multidisciplinary team consultation drew in specialists from cardiology, respiratory and critical care medicine, neurology, anesthesiology, endocrinology, nephrology, hematology, vascular surgery, and clinical nutrition. The team identified an extremely high perioperative risk of heart failure, acute myocardial infarction, respiratory failure, stroke, and renal failure, and recommended postoperative intensive care monitoring. Their standardized plan included inferior vena cava filter placement to reduce pulmonary embolism risk, daily supplementation of 800 to 1200 milligrams of elemental calcium with 1000 IU of vitamin D3, anti-infective therapy, moderate diuresis, a high-protein diet, and low-dose anticoagulation. Coronary and pulmonary CT angiography then confirmed a pulmonary embolism, forcing clinicians to balance anticoagulation against subcutaneous ecchymoses that signaled bleeding risk, settling on low-dose enoxaparin every 12 hours before switching to oral rivaroxaban.

Timing the revision surgery became a clinical tightrope. The patient’s cardiopulmonary symptoms improved by October 17, 2025, but her leg numbness and weakness kept deteriorating. After comprehensive reassessment on October 19, including CT pulmonary angiography, lower-extremity venous ultrasound, laboratory evaluation, electrolyte correction, and IVC filter placement, her overall condition stabilized. Only then did surgeons proceed, on October 23, with posterior thoracic laminectomy and decompression. Under general anesthesia and C-arm fluoroscopic guidance, they exposed the lamina from T8 to T12, performed partial laminectomy at T10, and thoroughly removed the leaked cement fragments to relieve pressure on the spinal cord. Blood loss was approximately 200 milliliters, vital signs remained stable, and no iatrogenic neurological injury occurred.

The reconstruction phase showcased surgical ingenuity adapted to fragile bone. Pedicle screws were inserted at T8, T9, T11, and T12, with bone cement augmentation at these adjacent levels to anchor the hardware in osteoporotic vertebrae. Critically, no additional cement was injected into the T10 vertebral body itself, a deliberate choice to strengthen screw purchase while minimizing the risk of recurrent leakage into the freshly decompressed canal. Autologous bone mixed with artificial bone was laid over the decorticated lamina to promote fusion. The authors attribute the original delayed leakage to three converging factors: the use of low-viscosity cement, which flows more readily and is prone to extravasation; staged injection, which created a weak junction between two cement masses; and severe osteoporosis, which allowed those cement segments to shift into the spinal canal weeks after the procedure.

Recovery unfolded along a measurable trajectory. Preoperatively, the patient scored 7 on the 10-point Visual Analogue Scale for pain, classified as ASIA grade C for spinal cord injury, with a Barthel Index of 30 out of 100 for daily activities. One week after revision surgery, her pain score had fallen to 2, muscle strength climbed to grade 3, and her Barthel Index reached 50. By three months, pain held at 1, muscle strength reached grade 4, sensory and urinary function had markedly improved, and her Barthel Index stood at 80, where it remained at six months. Follow-up CT confirmed stable fixation without loosening or breakage, uniform cement distribution without re-leakage, and no recurrence of spinal cord compression. She was discharged 16 days after surgery with continued clinical improvement.

The case carries lessons that reach beyond one operating room. A recent meta-analysis cited in the report found that high-viscosity bone cement was associated with a significantly lower leakage rate than low-viscosity cement during vertebroplasty, and the authors urge preferential use of high-viscosity material, strict control of injection volume and rate, and continuous fluoroscopic monitoring in high-risk osteoporotic patients. Symptomatic intraspinal leakage demanding surgery is genuinely rare: among 3175 vertebroplasty procedures in one cited study, only 4 cases required surgical treatment, and another analysis of 9 intraspinal leaks identified just 1 patient needing surgery for neurological deficit. Open revision remains the standard of care when progressive neurological deficit develops, but this case demonstrates that when neurological deterioration coexists with active pulmonary embolism, surgery should be timed after cardiopulmonary improvement and thromboembolic risk reduction rather than performed immediately or deferred indefinitely.

The authors acknowledge the limits of a single-patient report: no comparison group, incomplete imaging at some follow-up points, a six-month horizon too short to judge long-term construct stability, and findings from one institution in China that may not generalize elsewhere. Yet the core message stands with unusual clarity. For elderly patients with osteoporotic fractures and multiple comorbidities, the decision to perform primary vertebroplasty demands extreme prudence and thorough preoperative assessment of leakage risk. Once symptomatic leakage occurs, timely evaluation of neurological function and spinal stability must be followed by decisive open intervention when indicated, wrapped in meticulous optimization of the patient’s systemic condition. In an aging world where osteoporosis touches hundreds of millions of spines, this 84-year-old woman’s recovery offers a blueprint for how multidisciplinary medicine can rescue even the frailest patients from a complication that most procedures never see coming.

Subject of Research: Management of symptomatic intraspinal bone cement leakage after percutaneous vertebroplasty in an elderly patient with multiple comorbidities

Article Title: Management of bone cement leakage after percutaneous vertebroplasty in a geriatric patient with multimorbidity: a case report

Article References: Liu, S., Li, D., Wu, X., & Li, Y. (2026). Management of bone cement leakage after percutaneous vertebroplasty in a geriatric patient with multimorbidity: a case report. Frontiers in Musculoskeletal Disorders, 4, Article 1846800. https://doi.org/10.3389/fmscd.2026.1846800

Image Credits: AI Generated

DOI: 10.3389/fmscd.2026.1846800

Keywords: percutaneous vertebroplasty, bone cement leakage, osteoporotic vertebral compression fracture, spinal cord compression, multidisciplinary team, pulmonary embolism, geriatric surgery, pedicle screw fixation, high-viscosity cement, spine surgery, osteoporosis, case report