Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

Abstract Background Previous research and published literature indicate that some patients with spinal diseases who underwent percutaneous transforaminal endoscopic decompression (PTED) still suffer some discomfort in the early recovery stage in the form of pain, stiffness, and swelling. These are usually considered minor residual symptoms or normal postoperative phenomenon (NPF) in the clinic, occur frequently, and are acknowledged by surgeons worldwide. To the best of our knowledge, we report the first case of a patient who had an osteoporotic vertebral fracture (OVF) misdiagnosed as NPF after she underwent PTED as a result of lumbar disc herniation (LDH). Case presentation A 71-year-old female with Parkinson’s disease who presented with lower back pain radiating to the legs was diagnosed as LDH in L4–5, after which a PTED of L4–5 was performed, with temporary alleviation of symptoms. However, severe lower back pain recurred. Unfortunately, the recurred pain initially misdiagnosed as NPF, in fact, was finally confirmed to be OVF by CT-scan. OVF in the early stage of post-PTED seldom occurs and is rarely reported in the literature. With a percutaneous vertebroplasty, the pain was significantly relieved, and she resumed walking. After 36-weeks of follow-up, the pain improved satisfactorily. Conclusion Doctors should not immediately diagnose a relapse of back pain following PTED as NPF, and hands-on careful physical and imaging examinations are necessary to manage recurring pain rightly and timely.

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Presence of sarcopenia does not affect the clinical results of balloon kyphoplasty for acute osteoporotic vertebral fracture

Scientific Reports ◽

10.1038/s41598-020-80129-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shoichiro Ohyama ◽

Masatoshi Hoshino ◽

Shinji Takahashi ◽

Yusuke Hori ◽

Hiroyuki Yasuda ◽

...

Keyword(s):

Back Pain ◽

Vertebral Fracture ◽

Vertebral Deformity ◽

Short Form ◽

Balloon Kyphoplasty ◽

Clinical Results ◽

Osteoporotic Vertebral Fracture ◽

Mineral Density ◽

Hand Grip ◽

Sf 36

AbstractSarcopenia has been associated with poor clinical outcomes in several diseases. Herein, the clinical results of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fracture (OVF) treatment were assessed and compared between sarcopenia and non-sarcopenia patients. Sixty patients who underwent BKP for treatment of acute OVF with poor prognostic factors between April 2016 and September 2017 and were assessed for sarcopenia were enrolled. Clinical results (back pain on visual analogue scale [VAS]; short-form [SF] 36; vertebral deformity; activities of daily living levels; and incidence of adjacent vertebral fractures) were compared between the two groups at 6 months post-BKP. Data analysis revealed that back pain on VAS, SF-36 scores, and vertebral deformity improved from baseline to 6 months after BKP. Thirty-nine patients (65.0%) were diagnosed with sarcopenia and demonstrated a lower body mass index (21.2 vs. 23.3 kg/m2, p = 0.02), skeletal muscle mass index (5.32 vs. 6.55 kg/m2, p < 0.01), hand-grip strength (14.7 vs. 19.2 kg, p = 0.01), and bone mineral density of the femoral neck (0.57 vs. 0.76 g/cm2, p < 0.01) than those of patients without sarcopenia. However, no significant differences were observed in the clinical results between these groups. Therefore, BKP’s clinical results for the treatment of acute OVF are not associated with sarcopenia.

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Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial

Journal of Bone and Mineral Metabolism ◽

10.1007/s00774-016-0765-8 ◽

2016 ◽

Vol 35 (4) ◽

pp. 375-384 ◽

Cited By ~ 7

Author(s):

Naoto Endo ◽

Keiji Fujino ◽

Tokuhide Doi ◽

Masami Akai ◽

Yuichi Hoshino ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Back Pain ◽

Vertebral Fracture ◽

Controlled Trial ◽

Osteoporotic Vertebral Fracture ◽

Randomized Controlled ◽

Acute Back Pain ◽

Anti Inflammatory

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L2 Spinal Nerve–Block Effects on Acute Low Back Pain From Osteoporotic Vertebral Fracture

Journal of Pain ◽

10.1016/j.jpain.2009.03.002 ◽

2009 ◽

Vol 10 (8) ◽

pp. 870-875 ◽

Cited By ~ 13

Author(s):

Seiji Ohtori ◽

Masaomi Yamashita ◽

Gen Inoue ◽

Kazuyo Yamauchi ◽

Munetaka Suzuki ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Vertebral Fracture ◽

Nerve Block ◽

Spinal Nerve ◽

Osteoporotic Vertebral Fracture ◽

Low Back ◽

Acute Low Back Pain

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Simultaneous-onset infectious spondylitis with vertebral fracture mimicking an acute osteoporotic vertebral fracture erroneously treated with balloon kyphoplasty: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2135 ◽

2021 ◽

Vol 2 (12) ◽

Author(s):

Noritaka Yonezawa ◽

Yuji Tokuumi ◽

Nobuhiko Komine ◽

Takaaki Uto ◽

Yasumitsu Toribatake ◽

...

Keyword(s):

Back Pain ◽

Vertebral Fracture ◽

Compression Fracture ◽

Balloon Kyphoplasty ◽

Illustrative Case ◽

Osteoporotic Vertebral Fracture ◽

Paravertebral Abscess ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

Infectious Spondylitis

BACKGROUND Early balloon kyphoplasty (BKP) intervention for acute osteoporotic vertebral fracture (OVF) has been reported to be more effective than the conservative treatment. However, complications of early BKP intervention are still unknown. OBSERVATIONS A 71-year-old patient with OVF of L2 underwent BKP 2 weeks after symptom onset. Preoperative magnetic resonance imaging (MRI) and radiograph were compatible with new L2 OVF. Although computed tomography (CT) images revealed the atypical destruction of lower endplate of L2 as OVF, L2 BKP was planned. After BKP, his back pain improved dramatically. Two weeks after BKP, his lower back pain recurred. MRI and CT confirmed the diagnosis of infectious spondylitis with paravertebral abscess formation. With adequate antibiotic treatment and rehabilitation, he was symptom-free and completely ambulatory without signs of infection. LESSONS Signal changes on the fractured vertebral bodies during initial MRI and fractured vertebral instability on radiograph can mislead the surgeon to interpret the infection as a benign compression fracture. If the patients exhibit unusual destruction of the endplate on CT imaging, “simultaneous-onset” spondylitis with vertebral fracture should be included in the differential diagnosis. To determine the strategy for OVF, preoperative biopsy is recommended if simultaneous-onset spondylitis with vertebral fracture is suspected.

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