• Byung Gun Lim, Jea Yen Lee, Mi Kyoung Lee, Dong Kyu Lee, Jun Suk Kim, and Sang Sik Choi.
• Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, South Korea.
• Pain Physician. 2011 Nov 1;14(6):539-44.

BackgroundPercutaneous balloon kyphoplasty is an effective, minimally invasive procedure that is used to relieve pain and stabilize spine fractures caused by severe osteoporosis or osteolysis due to tumor metastasis. However, there remains a risk of bone cement leakage during and after kyphoplasty, especially in cases with severe vertebral wall destruction or neurological deficits.ObjectiveThis article presents a case in which kyphoplasty was used to manage these complications in a woman with vertebral compression fractures caused by tumor metastasis.Study DesignCase report.SettingPain management clinic.MethodsThe patient was a 76-year-old woman who had severe low back pain, lower extremity weakness, and cauda equina syndrome because of vertebral compression fracture and spinal metastasis with epidural involvement. The patient had a large bony defect in the vertebra that the bone filler device could pass freely through the anterior body wall. Nevertheless, kyphoplasty was successfully performed by using our new cement injection technique, which is a slow injection of the highly viscous bone cement, followed by a second injection 10 minutes later to allow the previously injected cement to harden.ResultsThe procedure significantly alleviated all symptoms. The day after the procedure, in the absence of additional pain medication, the pain had dropped dramatically to a numerical rating scale 3-4, and there was an improvement in motor function that allowed the patient to sit and go to the bathroom by herself. In addition, the voiding sensation had returned, which allowed the patient to defecate and urinate normally.LimitationsThis report describes a single case report.ConclusionOur new cement injection technique may allow balloon kyphoplasty to be safely and effectively performed in cancer patients with pathological vertebral compression fractures, even if there are large defects in the anterior vertebral wall and neurological deficits.

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