Percutaneous vertebroplasty-induced adjacent vertebral compression fracture

Area of Science:

• Orthopedics
• Interventional Radiology
• Pain Management

Background:

• Percutaneous vertebroplasty (PV) is a minimally invasive procedure for vertebral compression fractures (VCFs) with generally low risks.
• While PV offers significant patient improvement, adjacent VCFs can occur post-procedure, often requiring additional intervention.
• No prior studies have documented acute adjacent VCFs developing immediately following PV.

Observation:

• A 62-year-old woman presented with severe back pain after a fall, diagnosed with an acute T12 VCF.
• Following T12 PV, the patient experienced persistent pain, and imaging revealed an acute VCF in the adjacent T11 vertebra.
• A second PV was performed at T11, but subsequently, an L1 VCF developed, necessitating a third PV.

Findings:

• This case report describes the first instance of an acute adjacent vertebral compression fracture (VCF) occurring almost immediately after percutaneous vertebroplasty (PV).
• The patient required multiple PV procedures due to the development of sequential adjacent VCFs (T11 and L1) following the initial T12 PV.
• Radiographic evidence suggested that the insertion of the PV cannula into the T12 fracture line may have induced dynamic mobility, leading to adjacent VCFs.

Implications:

• This case highlights a rare but significant complication of PV, emphasizing the need for careful patient selection and procedural technique.
• The findings suggest a potential iatrogenic mechanism where PV instrumentation could destabilize adjacent vertebrae, causing new fractures.
• Further research is warranted to elucidate the exact pathogenesis and to develop strategies for preventing PV-induced adjacent VCFs.