Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2017; 5(8): 333-339
Published online Aug 16, 2017. doi: 10.12998/wjcc.v5.i8.333
Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report
Maria Pia Tropeano, Biagia La Pira, Lorenzo Pescatori, Manolo Piccirilli
Maria Pia Tropeano, Biagia La Pira, Lorenzo Pescatori, Manolo Piccirilli, Department of Neurology and Psichiatry-Neurosurgery, Policlinico Umberto I - Sapienza, University of Rome, 00185 Rome, Italy
Author contributions: Tropeano MP and Pescatori L designed work and wrote the manuscript; La Pira B researched the bibliography; Piccirilli M have supervised and corrected the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Sapienza University of Rome.
Informed consent statement: Patient was informed about the publication.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Pia Tropeano, MD, Department of Neurology and Psichiatry-Neurosurgery, Policlinico Umberto I - Sapienza, University of Rome, Viale del Policlinico 155, 00185 Rome, Italy. mariapia.tropeano@libero.it
Fax: +39-06-49979111
Received: October 18, 2016
Peer-review started: October 23, 2016
First decision: December 20, 2016
Revised: April 30, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: August 16, 2017
Abstract

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky.

Keywords: Subdural hematoma, Liposarcoma, Surgery, Radiotherapy, Vertebroplasty

Core tip: This is an original paper about a rare complication of vertebroplasty: A subdural hematoma. In literature there are only 4 cases described. To our knowledge thid is the first case in which this complication occur after 20 d. In this work we try to explain the pathogenesis and the importance of a correct and rapid diagnosis, and, if needed, an emergency treatment.