title: Cluster phenomenon of vertebral refractures after percutaneous vertebroplasty in a patient with glucocorticosteroid-induced osteoporosis: case report and review of the literature.
abstract: METHODS
  A case report and literature review.
  
  
  OBJECTIVE
  To describe a rare cluster phenomenon of spontaneous vertebral refractures in a patient with glucocorticosteroid-induced osteoporosis (GIOP) subsequent to percutaneous vertebroplasty (PVP) for the management of initial vertebral compression fractures (VCFs).
  
  
  BACKGROUND
  PVP has become the popular strategy for stabilizing osteoporotic VCFs and obtaining rapid pain alleviation and earlier restoration of mobility in both patients with primary osteoporosis and patients with glucocorticosteroid-induced osteoporosis. However, current data are insufficient to recommend routine use of PVP for VCFs caused by GIOP as recent retrospective studies indicate that the risk of vertebral refractures is much higher in patients with GIOP than those with primary osteoporosis.
  
  
  METHODS
  We reported a 63-year-old Chinese female with GIOP as well as pulmonary infection who underwent PVP for the management of initial VCFs, experienced the cluster phenomenon of spontaneous vertebral refractures.
  
  
  RESULTS
  Within a 4-month period, she underwent a total of 6 PVP operations with 13 cement-augmented vertebral bodies from T5-L5. Eleven refractures after the initial PVP procedures included 3 remote-level fractures, 4 adjacent-level fractures, 1 pincher body fracture, and 3 fractures in previously augmented bodies. The average interval between each PVP operation was 23.6 days.
  
  
  CONCLUSIONS
  The use of PVP as a therapeutic alternative for the treatment of VCFs in patients with GIOP is still controversial. As seen in our case, even when the management decisions were made in consideration of the patient's pulmonary infection, the outcome was disastrous with the cluster phenomenon of vertebral refractures. Current findings suggest a compelling need for high-quality studies investigating cement augmentation procedures in patients with VCF with GIOP.
authors: *Department of Orthopedic Surgery, Peking University First Hospital, China; and †Department of Orthopedics E, Aarhus University Hospital, Aarhus, Denmark.
authors: Haolin
authors: H
authors: Sun
authors: Shallu
authors: S
authors: Sharma
authors: Chunde
authors: C
authors: Li
mesh_terms: D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis / Q000601:surgery*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000150:complications / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods
chemical_list: D001843:Bone Cements; D005938:Glucocorticoids