Department of Orthopaedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., (R.O.C.), Taipei City, 231, Taiwan.
Department of Orthopaedic Surgery, National Taiwan University Hospital, Chung Shan S. Rd., Zhongzheng Dist., (R.O.C.), Taipei City, 100225, Taiwan.
BMC Musculoskelet Disord. 2022 Jun 2;23(1):529. doi: 10.1186/s12891-022-05472-w.
Vertebral compression fractures caused by osteoporosis are common in elderly patients and are often encountered by clinical physicians. Percutaneous balloon kyphoplasty (PKP) is widely accepted as a minimally invasive procedure for effectively relieving pain and correcting deformities, but complications may occur. Radiculopathy with a delayed onset caused by a retropulsed bone fragment has not been adequately described in the literature. Thus, this article presents a case report of four cases of retropulsed bone fragment-related radiculopathy after PKP.
In this article, we reported that four out of 251 patients developed radiculopathy after PKP between January 2012 and January 2019 despite experiencing substantial improvements in back pain. All patients with radiculopathy were female and diagnosed with osteoporosis, and their ages ranged from 68 to 89 years. Radiculopathy occurred from 2 to 16 weeks after PKP. All four patients underwent another operation (posterior decompression and instrumentation). Three patients recovered completely, and one died of postoperative intracranial haemorrhage. A detailed imaging study with pre- and postoperative magnetic resonance imaging (MRI) revealed that retropulsed bone fragments that impinged on the corresponding root after PKP were responsible for this complication, and all four patients developed a disrupted posterior vertebral rim preoperatively. No leakage of cement or pedicle track violations were observed.
Although PKP is a safe and effective treatment for painful osteoporotic vertebral compression fractures, a risk of catastrophic neurological injury remains. Radiculopathy with delayed onset caused by a retropulsed bone fragment after kyphoplasty is rare and challenging to treat, and the integrity of the posterior vertebral cortex should be carefully evaluated preoperatively to prevent this complication.
骨质疏松症导致的椎体压缩性骨折在老年患者中很常见，也是临床医生经常遇到的问题。经皮球囊扩张椎体后凸成形术（PKP）被广泛认为是一种有效的缓解疼痛和矫正畸形的微创方法，但也可能发生并发症。由骨碎片逆行引起的迟发性神经根病在文献中尚未得到充分描述。因此，本文报告了 4 例 PKP 后与骨碎片逆行相关的神经根病病例。
本文报道了 2012 年 1 月至 2019 年 1 月期间，251 例接受 PKP 治疗的患者中有 4 例发生了 PKP 后神经根病，尽管他们的背痛均有明显改善。所有神经根病患者均为女性，均诊断为骨质疏松症，年龄 68 至 89 岁。神经根病发生在 PKP 后 2 至 16 周。所有 4 例患者均接受了另一次手术（后路减压和内固定）。3 例患者完全恢复，1 例患者死于术后颅内出血。详细的影像学研究（术前和术后磁共振成像（MRI））显示，PKP 后压迫相应神经根的逆行骨碎片是导致该并发症的原因，所有 4 例患者术前均存在后缘椎体骨皮质破坏。未观察到水泥渗漏或椎弓根轨道侵犯。
虽然 PKP 是治疗疼痛性骨质疏松性椎体压缩性骨折的安全有效方法，但仍存在灾难性神经损伤的风险。PKP 后迟发性逆行骨碎片引起的神经根病罕见且难以治疗，术前应仔细评估后缘椎体皮质的完整性，以防止这种并发症。
