Background: The risks associated with percutaneous vertebroplasty (PV) are low. Patients
show marked improvement and are able to rapidly resume normal activities after PV. The sudden
development of postoperative vertebral compression fracture (VCF) is a common complication, and
additional PV is frequently performed in these cases. However, there have been no studies reporting
acute compression fractures of an adjacent vertebra immediately after PV.
Objective: This case report presents a rare case in which the patient had to undergo a second PV
because of PV-induced adjacent VCF. Further, we review previous studies and discuss the possible
pathogenesis of this rare complication.
Study Design: Case report.
Setting: Pain management clinic.
Methods: A 62-year-old woman presented with a severe pain in the lower back, which started
after she slipped. A radiograph showed severe vertebral collapse with a vertebral vacuum cleft in
the T12 vertebral body. T1-weighted magnetic resonance imaging showed low signal intensity in
T12, suggesting acute VCF, but the signals from the other vertebrae were normal.
Results: The patient underwent PV at T12. When the cannula was inserted into the fracture line
of the vertebral body, reduction of the collapsed T12 was developed. Although the postoperative
course was uneventful, the patient’s pain did not resolve. Postoperative radiographic image obtained
4 hours after the PV showed reduction of T12 and adjacent acute VCF in T11. We performed a
second PV at T11. However, 2 weeks later, adjacent acute VCF in L1 was developed and PV was
performed.
Limitations: This report describes a single case.
Conclusion: To the best of our knowledge, this is the first case report of adjacent VCF that developed
almost immediately after PV. Although the exact mechanism underlying this rare complication remains
unclear, we assume that the VCF was induced by PV, although this was not proven. However, we
suggest that the insertion of the cannula into the fracture line induced the iatrogenic dynamic mobility
of the fractured vertebra. Reduction was caused by the cannula and positional gravity. The upward
reduction may have had an effect on the upper and adjacent vertebrae.
Key words: Compression fractures, vertebroplasty, cannula, complication.
Treatment of a Compression Fracture at a Previously Instrumented Lumbar Vertebral Body Using Balloon Kyphoplasty: A Technical Case Report
