*Department of Orthopedic Surgery, Peking University First Hospital, China; and †Department of Orthopedics E, Aarhus University Hospital, Aarhus, Denmark.
Spine (Phila Pa 1976). 2013 Dec 1;38(25):E1628-32. doi: 10.1097/BRS.0b013e3182a8c488.
A case report and literature review.
To describe a rare cluster phenomenon of spontaneous vertebral refractures in a patient with glucocorticosteroid-induced osteoporosis (GIOP) subsequent to percutaneous vertebroplasty (PVP) for the management of initial vertebral compression fractures (VCFs).
PVP has become the popular strategy for stabilizing osteoporotic VCFs and obtaining rapid pain alleviation and earlier restoration of mobility in both patients with primary osteoporosis and patients with glucocorticosteroid-induced osteoporosis. However, current data are insufficient to recommend routine use of PVP for VCFs caused by GIOP as recent retrospective studies indicate that the risk of vertebral refractures is much higher in patients with GIOP than those with primary osteoporosis.
We reported a 63-year-old Chinese female with GIOP as well as pulmonary infection who underwent PVP for the management of initial VCFs, experienced the cluster phenomenon of spontaneous vertebral refractures.
Within a 4-month period, she underwent a total of 6 PVP operations with 13 cement-augmented vertebral bodies from T5-L5. Eleven refractures after the initial PVP procedures included 3 remote-level fractures, 4 adjacent-level fractures, 1 pincher body fracture, and 3 fractures in previously augmented bodies. The average interval between each PVP operation was 23.6 days.
The use of PVP as a therapeutic alternative for the treatment of VCFs in patients with GIOP is still controversial. As seen in our case, even when the management decisions were made in consideration of the patient's pulmonary infection, the outcome was disastrous with the cluster phenomenon of vertebral refractures. Current findings suggest a compelling need for high-quality studies investigating cement augmentation procedures in patients with VCF with GIOP.
病例报告及文献回顾。
描述一例糖皮质激素诱导骨质疏松症（GIOP）患者行经皮椎体成形术（PVP）治疗初始椎体压缩性骨折（VCF）后，罕见的自发性椎体再骨折簇现象。
PVP 已成为稳定骨质疏松性 VCF 并获得快速缓解疼痛和更早恢复活动能力的流行策略，无论是原发性骨质疏松症患者还是糖皮质激素诱导骨质疏松症患者。然而，目前的数据不足以推荐常规使用 PVP 治疗由 GIOP 引起的 VCF，因为最近的回顾性研究表明，GIOP 患者的椎体再骨折风险远高于原发性骨质疏松症患者。
我们报告了一例 63 岁的中国女性，患有 GIOP 和肺部感染，接受了 PVP 治疗初始 VCF，经历了自发性椎体再骨折簇现象。
在 4 个月的时间里，她总共接受了 6 次 PVP 手术，从 T5 到 L5 共进行了 13 次水泥增强椎体。初次 PVP 术后发生 11 处再骨折，包括 3 处远节段骨折、4 处相邻节段骨折、1 处钳夹体骨折和 3 处先前增强体骨折。每次 PVP 手术之间的平均间隔为 23.6 天。
PVP 作为治疗 GIOP 患者 VCF 的治疗选择仍存在争议。正如我们的病例所见，即使在考虑到患者肺部感染的情况下做出了治疗决策，结果仍然是灾难性的，出现了椎体再骨折簇现象。目前的研究结果表明，迫切需要进行高质量的研究，以调查 GIOP 合并 VCF 患者的水泥增强程序。
