Percutaneous vertebroplasty-induced adjacent vertebral compression fracture.

BACKGROUND 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. OBJECTIVE 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. STUDY DESIGN Case report. SETTING Pain management clinic. METHODS 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. RESULTS 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. LIMITATIONS This report describes a single case. CONCLUSION 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.