Delayed intradural hourglass-shaped bone cement leakage after percutaneous vertebroplasty: a case report

BACKGROUND: Percutaneous vertebroplasty (PVP) is widely used to stabilize vertebral compression fractures and alleviate pain. While immediate cement leakage is a known complication, delayed leakage is exceptionally rare, with very few reports worldwide. CASE PRESENTATION: We report a unique case of delayed bone cement leakage occurring 8 months post-PVP in a 60-year-old Chinese female with a history of osteoporotic vertebral compression fractures and multiple lumbar fusion surgeries. Initially presenting with successful postoperative recovery following PVP, the patient later developed new-onset lower back pain and radiculopathy of the bilateral lower limbs. Imaging revealed migration and leakage of cement into the intradural space with an hourglass pattern. Surgical intervention was undertaken to remove the leaked cement and alleviate neural compression, resulting in significant symptomatic improvement. The patient was monitored for an additional year without any recurrence of symptoms or new neurologic deficits. CONCLUSIONS: This case underscores the importance of long-term vigilance in high-risk PVP patients. Dynamic observation provides new insight into the pathophysiology of delayed leakage. Clinicians should consider prolonged radiologic monitoring in patients with severe osteoporosis, chronic glucocorticoid exposure, or prior fusion surgery.