Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Jeonbuk, Korea.
Pain Physician. 2012 Jul-Aug;15(4):E527-32.
The risks associated with percutaneous vertebroplasty (PV) are low. Patients show marked improvement and are able to rapidly resume normal activities after PV. The sudden development of postoperative vertebral compression fracture (VCF) is a common complication, and additional PV is frequently performed in these cases. However, there have been no studies reporting acute compression fractures of an adjacent vertebra immediately after PV.
This case report presents a rare case in which the patient had to undergo a second PV because of PV-induced adjacent VCF. Further, we review previous studies and discuss the possible pathogenesis of this rare complication.
Case report.
Pain management clinic.
A 62-year-old woman presented with a severe pain in the lower back, which started after she slipped. A radiograph showed severe vertebral collapse with a vertebral vacuum cleft in the T12 vertebral body. T1-weighted magnetic resonance imaging showed low signal intensity in T12, suggesting acute VCF, but the signals from the other vertebrae were normal.
The patient underwent PV at T12. When the cannula was inserted into the fracture line of the vertebral body, reduction of the collapsed T12 was developed. Although the postoperative course was uneventful, the patient's pain did not resolve. Postoperative radiographic image obtained 4 hours after the PV showed reduction of T12 and adjacent acute VCF in T11. We performed a second PV at T11. However, 2 weeks later, adjacent acute VCF in L1 was developed and PV was performed.
This report describes a single case.
To the best of our knowledge, this is the first case report of adjacent VCF that developed almost immediately after PV. Although the exact mechanism underlying this rare complication remains unclear, we assume that the VCF was induced by PV, although this was not proven. However, we suggest that the insertion of the cannula into the fracture line induced the iatrogenic dynamic mobility of the fractured vertebra. Reduction was caused by the cannula and positional gravity. The upward reduction may have had an effect on the upper and adjacent vertebrae.
经皮椎体成形术（PV）相关风险较低。患者术后即刻疼痛明显改善，并能迅速恢复正常活动。术后椎体压缩骨折（VCF）的突然发生是一种常见并发症，通常会在这种情况下再次进行 PV。然而，目前还没有研究报道 PV 后即刻发生相邻椎体急性压缩骨折。
本病例报告报道了一例因 PV 引起相邻 VCF 而不得不再次进行 PV 的罕见病例。此外，我们还回顾了以往的研究，并讨论了这一罕见并发症的可能发病机制。
病例报告。
疼痛管理诊所。
一位 62 岁女性因滑倒后出现严重腰痛就诊。X 线片显示 T12 椎体严重塌陷伴椎体真空裂隙。T1 加权磁共振成像显示 T12 信号强度低，提示急性 VCF，但其他椎体信号正常。
患者在 T12 行 PV。当将套管插入椎体骨折线时，T12 塌陷得到复位。尽管术后过程顺利，但患者的疼痛并未缓解。PV 术后 4 小时的影像学检查显示 T12 复位和相邻 T11 的急性 VCF。我们在 T11 行第二次 PV。然而，2 周后，L1 发生相邻急性 VCF，再次进行 PV。
本报告仅描述了 1 例病例。
据我们所知，这是首例 PV 后几乎立即发生相邻 VCF 的病例报告。尽管这种罕见并发症的确切机制尚不清楚，但我们假设 VCF 是由 PV 引起的，尽管这尚未得到证实。然而，我们建议套管插入骨折线会导致骨折椎体的医源性动态活动。复位是由套管和位置重力引起的。向上复位可能对上节段和相邻节段产生影响。
