Delayed Neurological Deficits Caused by Epidural Leakage of Intravertebral Contents in a Patient With Osteoporotic Vertebral Fracture

Delayed neurological deficits (DND) after osteoporotic vertebral fractures (OVF) are a rare but serious complication. In patients with Parkinson's disease (PD), involuntary movements such as dyskinesia may increase biomechanical stress, potentially exacerbating spinal instability. We report the case of a 74-year-old woman with PD and a history of T12 OVF, who presented with progressive bilateral thigh pain and gait disturbance despite conservative treatment and bed rest. Imaging revealed a posterior epidural mass at T12 with an atypically high CT attenuation (300-340 hu), inconsistent with hematoma. MRI demonstrated a fluid level within the T12 vertebral body, suggesting vertebral instability and possible content extrusion. Emergency surgery, including vertebroplasty, posterior instrumentation, and decompressive laminectomy, was performed. The epidural lesion was pathologically identified as extruded vertebral contents, including hematopoietic marrow, fatty tissue, bone fragments, and necrotic debris, with no evidence of hematoma, inflammation, or malignancy. The patient experienced rapid postoperative improvement and was discharged ambulatory. She remained neurologically intact at the 18-month follow-up. This case highlights a rare mechanism of DND in OVF: epidural migration of vertebral contents through posterior wall failure, where dyskinesia may have been a contributing factor. Such lesions may mimic hematomas but show atypical imaging characteristics. Awareness of this pathology, along with timely surgical intervention and pathological confirmation, is crucial for accurate diagnosis and favorable outcomes in similar patients.