Failed Percutaneous Vertebroplasty Due to Insufficient Correction of Intravertebral Instability in Kummell's Disease: A Case Report.
Kummell's disease, caused by osteonecrosis of the vertebral body, is a cause of vertebral collapse. In Kummell's disease, intravertebral instability from nonunion between the cement and bone after percutaneous vertebroplasty (PVP) can cause persistent severe pain and dysfunction. A 75-year-old woman presented with severe pain in the lower back, both buttocks, groin, and both posterior thighs for a period of 30 days. Lumbar radiographs and magnetic resonance images showed an acute compression fracture of the first lumbar vertebra with an intravertebral cleft filled with fluid. The patient underwent PVP for the L1 compression fracture; however, this failed to provide sufficient pain relief. The patient was re-evaluated with dynamic radiography, and intravertebral instability and bone cement displacement of the L1 vertebra were detected. Repeat PVP was performed. After the procedure, intravertebral instability was restored and her pain completely subsided. PVP is a good treatment choice for symptomatic Kummell's disease. However, there is no consensus on the best technique of injecting bone cement to achieve optimal results. It is important to inject more bone cement than the volume of the intravertebral cleft to prevent instability caused by nonunion in PVP for Kummell's disease. We report a case of failed PVP because of insufficient correction of intravertebral instability in Kummell's, along with a review of the literature.
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.
Jung Eun
JE
Kim
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.
Sang Sik
SS
Choi
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.
Mi Kyoung
MK
Lee
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.
Dong Kyu
DK
Lee
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.
Seung Inn
SI
Cho
D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging; D010020:Osteonecrosis / Q000150:complications; D012086:Reoperation / Q000379:methods*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements
Kummell's disease; intravertebral instability; intravertebral vacuum cleft; nonunion; percutaneous vertebroplasty; vertebral compression fracture