Abstract
HIGHLIGHTS: To discuss a rare complication of prone positioning during kyphoplasty.To compare two rare causes of anterior spinal artery infarct secondary to prone positioning: Surfer Myelopathy and post-kyphoplasty myelopathy. BACKGROUND: Kyphoplasty is a common, minimally invasive procedure performed to restore vertebral body structure and relieve pain in insufficiency fractures that are refractory to conservative treatments. Complications are infrequent, but typically arise from epidural hematoma, cement embolism, or cement extravasation causing stenosis within the spinal canal or neural foramina. In this case, we discuss a rare complication involving a spinal cord infarct developing several levels above the level of intervention due to compression of the anterior spinal artery. CASE PRESENTATION: A 71-year-old female with kyphotic deformity and midthoracic compression fractures underwent a procedurally uneventful T12 kyphoplasty. Pre-procedure MRI demonstrated T12 superior endplate compression deformity with mild retropulsion of the superior endplate. Chronic T6 and T8 compression fractures with kyphotic deformity were also seen. Shortly after the procedure, she developed right leg pain and numbness progressing to profound weakness. She was taken immediately for CT scan of the thoracolumbar spine which was negative for cement extravasation, and subsequent MRI was negative for epidural hematoma. The MRI did show a peculiar finding of spinal cord infarct from T8 to the conus with punctate hemorrhage at T11. CONCLUSIONS: It is postulated that the incomplete cord infarct in this patient occurred due to compression of the anterior spinal artery or radicular arteries during positioning in the setting of kyphotic deformity and posterior osteophyte. The dysmorphic changes seen at T8 may have behaved similarly to a disc herniation in compressing the spinal artery in a prone position.