Severe vertebra collapse due to vertebra osteonecrosis after percutaneous vertebroplasty

Abstract

A 70-year-old woman complained of 2-week history of severe back pain and restricted motion after a traffic accident. A magnetic resonance imaging of the lumbar spine showed a T12 compression fracture (Figure A) and severe osteoporosis (T score: −3.4); visual analogue scale (VAS) score was 9. Bilateral percutaneous vertebroplasty was performed and a total of 4.5 mL of polymethylmethacrylate (PMMA) bone cement was injected (Figure B,C). The patient was totally free of back pain, and the VAS score was improved to be 3 at 1 week after surgery. She received risedronate sodium (5 mg/ day) and thoracolumbar hyperextension brace fixation for 1 month. However, on the 86th day after surgery, she complained of enhanced back pain without specific accident. A physical examination showed VAS score was 5, plain radiograph showed a T12 vertebra collapse and kyphoscoliosis (Figure D). Sagittal computed tomography (Figure E) and magnetic resonance imaging (Figure F) demonstrated a T12 intravertebral vacuum cleft sign, suggesting the possibility of a T12 vertebral osteonecrosis. We suggested percutaneous vertebroplasty for further treatment, but the patient refused. Wentao Wang, MD Kun Duan, MD Qu Wei, MD Qining Wu, MD Jijun Liu, MD Dingjun Hao, MD Department of Spine Surgery Hong Hui Hospital Xi’an Jiaotong University Health Science Center No. 555 East Youyi Rd, Beilin District Xi’an 710054, Shan’xi, China Department of General Surgery The 417th Hospital China National Nuclear Corporation (CNNC) No. 5 Kangfu Rd, Lintong District Xi’an 710061, Shan’xi, China