Percutaneous Vertebroplasty for Cephalad Vertebral Fractures After Instrumented Lumbar Fusion

Seo, Jun-Yeong; Ha, Kee-Yong; Son, Il-Nam; Chang, Dong‐Gune; Kim, Young-Hoon

doi:10.1097/bsd.0b013e31826103f2

Cited by 1 publication

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“… 2 Prophylactic vertebroplasty was recommended for augmenting the strength of the UIV and adjacent vertebra. 8 , 15 Nevertheless, there are still debates over the protective function of prophylactic vertebroplasty. In a biomechanical cadaveric study, 15 prophylactic vertebroplasty at the UIV and its supra-adjacent vertebra reduced the incidence of junctional fractures after long instrumented lumbar fusion.…”

Section: Discussionmentioning

confidence: 99%

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Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

Chen

2016

TCRM

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BackgroundPedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images.Case presentationAn 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury.ConclusionAdjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock.

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Section: Discussionmentioning

confidence: 99%

“…On August 29, 2013, she underwent a revision surgery for the correction of T12 subluxation, cephalad extension of instrumented fusion to T9, and prophylactic T8 vertebroplasty. 5 , 8 She wore a hyperextension brace postoperatively. The radiographs showed restored alignment of the spine ( Figure 2 ).…”

Section: Case Presentationmentioning

confidence: 99%

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

Chen

2016

TCRM

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Percutaneous Vertebroplasty for Cephalad Vertebral Fractures After Instrumented Lumbar Fusion

Abstract: Although PVP treatment may be a useful method for cephalad vertebral fractures after instrumented lumbar fusion in elderly patients with persistent unremitting back pain, recollapse of the vertebral body can occur after a PVP for cephalad or adjacent vertebral fractures with an IVC.

Cited by 1 publication

References 19 publications

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

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