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

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.

Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis

Background This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA. Methods Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP. Results KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures. Conclusions OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use. Trial registration Retrospectively registered.

Combined Radiofrequency Ablation and Balloon Kyphoplasty Following Radiation Therapy for Spinal Metastases and Associated Pain. A Case Report

BACKGROUND: The spine is a common area of metastasis to the bone. Radiation therapy has been the standard treatment for focal metastatic spine tumors, and although it has shown an ability to reduce pain, it is not curative for all patients and can negatively impact a patient’s quality of life. Treating spinal metastatic pain with the use of radiofrequency ablation (RFA) in combination with kyphoplasty has been shown to be safe and effective in the treatment of spinal metastatic pain. We present a case of using balloon kyphoplasty with OsteoCoolTM RFA for treating both spinal metastasis and pain. CASE REPORT: A 65-year-old man with a history of prostate cancer presented with metastasis to the L1 vertebral body and chronic low back pain refractory to multimodal pharmacologic treatment. He previously had radiation therapy for this bone metastasis and was maintained on enzalutamide for prostate cancer with decreasing prostate-specific antigens followed by hematology/oncology. Balloon kyphoplasty with OsteoCool RFA was performed with resolution of the patient’s pain as well as the tumor metastasis. CONCLUSION: To our knowledge, there is no available literature discussing the administration of all the above (i.e., RFA, kyphoplasty/vertebroplasty, radiation) together, the sequence in which they are performed, the benefits and consequences of the treatment sequence, the time to and level of pain relief, and differences in radiation exposure. The results of this case provide a clinical rationale for performing RFA and kyphoplasty prior to radiation treatment, while further studies should be conducted to further elucidate the best administration of this treatment. KEY WORDS: Back pain, bone, cancer, kyphoplasty, metastasis, radiation, radiofrequency ablation, vertebroplasty