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

Rationale Although percutaneous vertebroplasty (PVP) is a minimally invasive treatment for osteoporotic vertebral compression fractures, bone cement leakage remains a serious complication. Management becomes particularly challenging in elderly patients with multiple comorbidities. Patient concerns An 84-year-old woman with severe osteoporosis underwent PVP for a T10 vertebral fracture. Postoperatively, she developed progressive low back pain, bilateral lower limb weakness, and urinary dysfunction. She had multiple comorbidities, including pulmonary embolism, coronary artery disease, grade 3 hypertension, and deep vein thrombosis, which significantly increased perioperative risk. Diagnoses Primary diagnosis: Intraspinal space-occupying lesion secondary to bone cement leakage after PVP, with thoracic spinal cord injury and incomplete paraplegia. Direct complication: Intraspinal cement leakage at T10 with spinal cord compression. Relevant comorbidities included pulmonary embolism, postherpetic neuralgia, pulmonary hypertension, lumbar stenosis, and multiple systemic conditions. Interventions After multidisciplinary team consultation, the patient underwent posterior thoracic laminectomy, removal of leaked cement, pedicle screw fixation with bone cement augmentation at adjacent levels, and bone grafting. Perioperative management included anticoagulation adjustment, electrolyte correction, inferior vena cava filter placement, and anti-osteoporotic therapy. Outcomes The patient showed significant pain relief and neurological improvement postoperatively. No surgical complications occurred. Follow-up imaging confirmed stable fixation without re-leakage. At six months, she demonstrated continued clinical improvement and better quality of life. Conclusion Comprehensive preoperative evaluation, timely surgical intervention, and multidisciplinary management are essential for favorable outcomes in elderly patients with cement leakage after PVP.