Abstract
In November 2011 a 75-year-old man was admitted to our emergency department with a low back pain caused by a traumatic L1 vertebral collapse with backward projection of posterior wall superior third. The indication for neurosurgical instrumentation was placed, although he refused the treatment. Hence he was treated conservatively without a significant improvement up to January 2012 when, still refusing surgery, he accepted to undergo percutaneous vertebroplasty with a novel bioactive injectable strontium-hydroxyapatite cement. Vertebroplasty was performed without complications. A CT scan, performed the day after the procedure, ruled out extravertebral cement leakage. Pain improvement was significant (preprocedure VAS 10, one-week VAS 4) with a gradual decrease up to three months when it stabilized at 2. CT examination after 1 year showed a good cement osseointegration with osteophytic spurs bridging the superior endplate of the level involved to the inferior one of the level above. The new bone ingrowing property of the strontium-hydroxyapatite containing cement permits to extend the treatment indication also to unstable collapses in which the risk of pseudoarthrosis is very high. In this reported case we evaluated the potential role of percutaneous vertebroplasty in traumatic burst fracture with spinal channel involvement.
Highlights
Acute vertebral compression fractures are common and can occur secondary to osteoporosis, trauma, neoplasm, metastasis, or myeloma [1].Different approaches for the management of painful VCFs are currently available, but the treatment depends on the neurological status of the patient, features of the fracture, and its pathogenesis
Numerous improvements have been made in the last years, due to the introduction in clinical practice of minimally invasive techniques such as percutaneous vertebroplasty (PVP) and kyphoplasty (PKP)
PVP is considered a very safe and effective procedure in treating painful primary or secondary osteoporotic refractory to medical therapy, compression fractures caused by osteonecrosis [4, 5], or neoplasm [6,7,8]
Summary
The indication for neurosurgical instrumentation was placed, he refused the treatment. He was treated conservatively without a significant improvement up to January 2012 when, still refusing surgery, he accepted to undergo percutaneous vertebroplasty with a novel bioactive injectable strontiumhydroxyapatite cement. The new bone ingrowing property of the strontium-hydroxyapatite containing cement permits to extend the treatment indication to unstable collapses in which the risk of pseudoarthrosis is very high. In this reported case we evaluated the potential role of percutaneous vertebroplasty in traumatic burst fracture with spinal channel involvement
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