Foreign body granuloma after bone cement augmentation of pedicle screws for osteoporotic spinal surgery: A case report

Osteoporosis causes a decrease in bone mineral density. To overcome the decrease in fixation strength, a variety of techniques and devices have been developed, including cement augmentation of pedicle screws. Polymethyl methacrylate (PMMA), is commonly known as bone cement, and is widely used for implant fixation in various orthopaedic and spine surgery. In general, PMMA augmentation of pedicle screws is simple and safe if performed with technical precautions. PMMA is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone cement-related epidural space foreign body granuloma. Neurology Asia 2016; 21(4) : 385 – 388 Address correspondence to: Seung-Wook Baek, MD, PhD, Department of Orthopaedic Surgery, Spine center, Hyemin General Hospital, Seoul, Korea. TEL: 82-2-2049-9050, E-mail: [email protected] INTRODUCTION Osteoporosis causes a decrease in bone mineral density. As bone mineral density decreases, the force required for pedicle screw pullout decreases. To overcome the decrease in fixation strength, a variety of techniques and devices have been developed, including cement augmentation of pedicle screws. In general, polymethylmethacrylate (PMMA) cement augmentation of pedicle screws is simple and safe if performed with precautions. However, serious complications such as pulmonary emboli and paraplegia may occur if bone cement leaks into the pulmonary artery or spinal canal. In this report, we present a case with reactive changes and foreign body granuloma, in intraspinal cement leakage area after cement augmentation.