Spinal cord injury following osteoporotic vertebral fracture: case report

This report details the sudden catastrophic neurologic deterioration concerning a patient with an acute fracture of T5 associated with osteoporosis.

To describe a unique presentation of abrupt spinal cord injury in this condition.

Vertebral fractures occur frequently in osteoporosis, but associated spinal cord injury is a rare occurrence. When neurologic injury occurs it is generally of a very low incidence and with a gradual onset, and spontaneous recovery can be expected. Most reports in the literature are of delayed-onset paraplegia after vertebral collapse. We report a unique case of a sudden and catastrophic thoracic spinal cord injury occurring spontaneously.

An 88-year-old woman had a sudden thoracic vertebral fracture with complete spinal cord injury while attempting to get out of bed. She was treated with continuous oral corticosteroids for >40 years for both rheumatoid arthritis and restrictive lung disease. She was never investigated or treated for osteoporosis.

Plain radiographs indicated multilevel osteoporotic fractures throughout the spine with diffuse, marked osteopenia. Magnetic resonance imaging scans showed changes in keeping with severe vertebral osteoporosis and spinal cord injury. She was treated nonoperatively in view of the extremely osteoporotic spine and her overall poor medical condition. Despite an initial improvement in her respiratory condition with medical therapy, she died 72 hours following admission.

With increasing awareness of the morbidity attached to the osteoporotic spine, investigation and pharmacologic treatment are warranted and may reduce the possibility of catastrophic neurologic impairment as occurred in this case.