Abstract
This report presents a case of short-term symptomatic failure with continued vertebral collapse after a T12 kyphoplasty for an acute fracture in a severely osteoporotic elderly patient. The original trajectory of the unilateral balloon and subsequently injected bone cement failed to fill the fracture, allowing further vertebral collapse that resulted in a rapid return of pain. Within 30 days, a titanium intravertebral body implant, SpineJack® (Stryker Corp, Kalamazoo, MI), combined with injection of polymethylmethacrylate (PMMA) bone cement, was placed in the collapsed area. This provided both sagittal and coronal partial correction of the collapse, fuller distribution of bone cement throughout the fractured vertebrae, and rapid reduction of pain. which was found to have been maintained at the long-term follow-up. The article reviews the technical issues causing failure of vertebral augmentation (VA) as well as the advantage of providing a permanent internal scaffolding to ensure stabilization of any fracture, especially where there is a high risk for progressive instability, such as the thoracic-lumbar junction.
Highlights
Vertebral augmentation (VA) procedures include both vertebroplasty and kyphoplasty and, currently, thirdgeneration implantable expanders all supplemented with bone cement
There is a clear role for repeat VA in previously treated vertebrae when there is a progression of the fracture and deformity, or if the patient develops recurrent pain [13,14]
There was vacuum change in both the T10-T11 and T11-T12 disc spaces, and these changes and associated intravertebral clefts are often associated with an unstable fracture that may be more prone to progression despite VA [13]
Summary
Vertebral augmentation (VA) procedures include both vertebroplasty and kyphoplasty and, currently, thirdgeneration implantable expanders all supplemented with bone cement. There is asymmetric collapse of the superior endplate of T12 more on the left side (dashed black arrow) She was sent to a neurosurgeon, to whom she stated that her pain had subsided after wearing the support, She had an MRI, 2.5 months after the fall, which showed the T12 fracture with edema of the superior 50% of T12 under the superior endplate of the T12 vertebral body. B: lateral image after insertion shows previous cement (dashed white outline) inferiorly and into the lower disc space compared to new PMMA cement fill from anterior to the posterior part of the fractured vertebrae especially under the superior endplate
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