Percutaneous vertebroplasty of the entire thoracic and lumbar vertebrae for vertebral compression fractures related to chronic glucocorticosteriod use: case report and review of literature

Multilevel percutaneous vertebroplasty with the Spine Jack® system in a patient with Cushing disease

BACKGROUND

Percutaneous vertebroplasty (PV) is a minimally invasive procedure that requires the injection of cement into a fractured vertebral body. Spine Jack® is a vertebroplasty system with an intracorporal implant designed to restore the height of the vertebral body in osteoporotic vertebral fractures. There are no reported cases of PV with Spine Jack® system as treatment for multilevel compression fractures in patients with vertebral osteoporosis due to Cushing disease.

CASE PRESENTATION

A 55-year-old man with lumbago, impaired deambulation 6 weeks prior to presentation, with Oswestry score of 72% and a visual analogue scale (VAS) score of 9 points. Imaging studies showed osteoporotic fractures at T5, T8, T11, T12, and L1-L5 vertebrae secondary to Cushing disease. PV was performed with a Spine Jack® intracorporal implant device, in three sessions, and multiple levels were operated at each intervention. Post-operative course demonstrated improvement of pain, height, correction of the kyphotic angle and Oswestry score, without any neurological deficits despite having nine vertebral fractures.

CONCLUSION

Percutaneous vertebroplasty with the Spine Jack® system is a safe and effective procedure to treat multilevel vertebral fractures due to Cushing disease, improving the quality of life and allowing the patient to remain pain-free while avoiding major surgery.

Management of glucocorticoid-related osteoporotic vertebral fracture

The vertebral column is the most common site of osteoporotic fractures in long-term users of glucocorticoids. Vertebral fracture leads to significant morbidities such as unrelenting pain, spinal deformities and reduced mobility, leading to diminished quality of life. Epidemiological data on the prevalence of glucocorticoid-induced vertebral fractures are limited. As vertebral fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews recent data on the prevalence of vertebral fractures in glucocorticoid users, fracture risk stratification, and evidence-based treatment options. The risk of osteoporotic fractures estimated by FRAX should be adjusted for glucocorticoid users. The first-line treatment of glucocorticoid-induced osteoporosis remains the bisphosphonates. Teriparatide and denosumab are alternative options. Percutaneous vertebroplasty and kyphoplasty may be considered for symptomatic control of acute vertebral fracture-related pain when conservative measures fail.

Update on Symptomatic Treatment of Acute Vertebral Compression Fracture

The vertebral column is the most common site of osteoporotic fracture in older individuals and in those using long-term glucocorticoids. Vertebral compression fracture leads to significant morbidities such as acute and chronic pain, spinal deformities and neurological complications, resulting in reduced mobility and quality of life. As a previous vertebral compression fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews the management of osteoporotic vertebral compression fracture and provides evidence-based treatment options.

Feasibility of percutaneous interbody fusion as a treatment for adjacent vertebral stress fracture of ankylosing spondylitis with intervertebral pseudarthrosis formation

OBJECTIVE

The objective of this study was to evaluate the feasibility of percutaneous interbody fusion (PIF) using bone cement for adjacent vertebral stress fracture of ankylosing spondylitis (AS) with intervertebral pseudarthrosis formation.

PATIENTS AND METHODS

From January 2010 to February 2018, eleven consecutive patients (seven men and four women; median age, 56.09±13.64 years; age range, 33-80 years) who underwent PIF as a treatment for adjacent stress fracture of AS with intervertebral pseudarthrosis formation were retrospectively analyzed. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score were assessed before and after the procedure; meanwhile, the procedure duration, length of hospital stay and complications were assessed. Moreover, anterior/lateral and computed tomography (CT) scans were utilized for the assessment of bone cement distribution and interbody fusion.

RESULTS

Technical success was achieved in all patients, and they experienced good interbody fusion with bone cement after PIF. Mean VAS scores declined significantly from 8.82±0.87 before the procedure to 3.36±0.67 1 day after the procedure and 2.73±0.65 1 month after the procedure, while the mean ODI scores decreased from 82.91±3.02 before treatment to 31.64 ±2.66 1 day after treatment and 30.00±3.10 1 month after treatment. The mean procedure duration was 49.73±6.12 minutes (range, 42-65 minutes). The average length of hospital stay was 7.09±1.45 days (range, 5-10 days). Extraosseous cement leakage occurred in one case without causing any clinical complications.

CONCLUSION

PIF is a feasible therapeutic technique for adjacent vertebral stress fracture of AS with intervertebral pseudarthrosis formation, which can significantly relieve pain and stabilize the fractured spine.