Cha Jun-Yong, Choi Sangsoo, Kim Sungbum, Jang Il-Tae
Department of Spine Surgery, Gangnam Nanoori Hospital, Seoul, Korea.
Korean J Neurotrauma. 2025 Jul 18;21(3):216-221. doi: 10.13004/kjnt.2025.21.e23. eCollection 2025 Jul.
Spinal fusion with metallic implants is a widely used surgical approach to manage various spinal pathologies including instability and degenerative diseases. Although spinal instrumentations facilitate successful bone fusion by providing immediate rigid support and stability, their removal may be necessary because of pain, mechanical failure, or infection. However, implant removal, particularly in patients with low bone density, may lead to fractures of the fused vertebral bodies owing to stress-shielding effects. This case report describes a 70-year-old woman with a history of spinal fusion surgery at the L3-L4-L5 levels who underwent another spinal fusion surgery at the L5-S1 level and removal of previous implants owing to adjacent segment disease. During recovery, the patient developed sudden severe back pain due to vertebral body fractures at the L3 and L4 levels following manual therapy. Percutaneous vertebroplasty was performed to treat these fractures and allowed for recovery without any complication. This case highlights the importance of careful preoperative planning and postoperative management in preventing fractures associated with hardware removal.
使用金属植入物进行脊柱融合术是一种广泛应用的外科手术方法，用于治疗包括脊柱不稳和退行性疾病在内的各种脊柱病变。尽管脊柱内固定通过提供即时的刚性支撑和稳定性促进了成功的骨融合，但由于疼痛、机械故障或感染，可能需要取出植入物。然而，取出植入物，尤其是在骨密度低的患者中，由于应力屏蔽效应，可能会导致融合椎体骨折。本病例报告描述了一名70岁女性，她有L3-L4-L5节段脊柱融合手术史，因相邻节段疾病在L5-S1节段接受了另一次脊柱融合手术并取出了先前的植入物。在恢复过程中，患者在手法治疗后因L3和L4节段椎体骨折出现突然严重的背痛。进行了经皮椎体成形术治疗这些骨折，患者得以康复且无任何并发症。本病例强调了在预防与取出内固定相关的骨折方面，仔细的术前规划和术后管理的重要性。
