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Upper left panel: preoperative computed tomography (CT) sagittal image showing leaked polymethyl methacrylate (PMMA) into spinal canal from T6 thorough T7. Upper right panel: preoperative CT axial image showing circumferentially leaked PMMA surrounding the thecal sac. Lower left panel: axial CT image showing leaked PMMA into the segmental vein bilaterally (white arrow head). Lower right panel: axial CT image showing leaked PMMA into right pulmonary artery (white arrow).
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Computed tomography (CT) revealed a massive leakage of PMMA into the T6 and T7 spinal canal circumferentially surrounding the spinal cord that caused marked encroachment of the thecal sac, and small pieces of leaked PMMA embolized to the left pulmonary artery ( Fig. 1 ).
Magnetic resonance sagittal and axial images showing compressed spinal cord by leaked polymethyl methacrylate and intramedullary high-signal change.
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Magnetic resonance imaging (MRI) revealed cord compression due to epidural PMMA and intramedullary signal change from T6 to T7 level ( Fig. 2 ).
Cadaveric study to evaluate the safety of removal of polymethyl methacrylate (PMMA) from dura mater. Left panel: PMMA was plastered on the dura mater to reproduce PMMA leakage into spinal canal. Right panel: PMMA was easily detached from dura mater of the cadaveric spine.
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PMMA was plastered on the dura to reproduce the epidural leakage ( Fig. 3 ).
Left: intraoperative image showing polymethyl methacrylate (PMMA) detached from the dura mater. Right: eight pieces of detached PMMA fragments.
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Eight pieces of PMMA were detached from the dura mater relatively easily without causing a dural tear ( Fig. 4 ).