Percutaneous kyphoplasty for the treatment of osteoporotic thoracolumbar fractures with neurological deficit: radicular pain can mimic disc herniation.

Osteoporotic vertebral fractures (OVFs) are the common disease found in elderly population. Neurological deficit in OVFs is rare despite the involved posterior cortex of the fractured vertebral body, severe kyphotic deformity, or the instability at the fracture site. OVF with resulting neurological deficit was considered as a contraindication for vertebral augmentation techniques. We reported a rare case of a 75-year-old woman with L1, L2 osteoporotic vertebral fractures and L5/S1 disc herniation who presented with back pain and radicular pain extending along the posterior aspect of the left leg. Physical examination showed slight weakness of her flexor hallucis longus and absence of ankle jerk on her left leg. The result of a straight leg-raising test was limited to an angle of 50 degrees. The radiographs showed that the nerve root was compressed by the retropulsed bone fragment of the L2 vertebral body and a herniated disc at the level of L5/S1 on the left side. After L1 and L2 kyphoplasty the radicular pain as well as the back pain was completely disappeared. At her two-year follow-up examination, the patient was completely symptom free and reported no radicular pain. This case suggested that minimally invasive techniques such as kyphoplasty or vertebroplasty are effective in certain OVF patients with neurological deficit. Radicular pain could be caused by osteoporotic fracture that involves the posterior cortex of the vertebral body. Understanding the anatomy of nerve roots and pathogenetic mechanism of radicular pain is particularly important for treatment option.