Multilevel Compression Fracture Initiated by Unrestrained Electroconvulsive Therapy for Treatment Resistant...

Depression is the most common cause of emotional disorders in older adults with electroconvulsive therapy (ECT) as the preferred treatment for older adults. ECT utilizes a controlled therapeutic seizure resulting in repetitive muscle contractions, which carries the risk of fractures and dislocations.

This is an unusual case of a 69-year-old man with a history of treatment-resistant depression developing severe midback pain and a multilevel compression fracture after treatment without a well-defined incidence following utilization of ECT. Anteroposterior and lateral x-rays of the thoracic spine demonstrated a 2-level compression. The patient was a candidate for kyphoplasty. Bone density was age appropriate. On follow-up, the patient denied pain with healing of the fracture without augmentation. Initiation of physical therapy was recommended.

Individuals with age-appropriate nonosteoporotic bones can develop fractures during ECT. Back pain following ECT may be associated with a vertebral compression fracture, especially in older adults.