Paraparesis due to refracture of a previously cemented vertebra and new fracture of the adjacent vertebra after kyphoplasty for an osteopenic thoracolumbar burst fracture: a case report

Abstract

Although adjacent-level fracture is a well-known complication after vertebroplasty (VP) or kyphoplasty (KP), refracture of a cemented vertebra is a relatively rare complication. Moreover, it is very uncommon for 2 fractures to occur in a single patient, and exceptionally rare for refracture to cause spinal cord (SC) compression or neurological deficits. We report a case of paraparesis due to refracture of a cemented vertebra and a new fracture of an adjacent vertebra after KP. An 80-year-old woman underwent KP for an osteopenic burst fracture at T12 with an intravertebral vacuum cleft (IVC). Six weeks post-KP, the patient presented with pain and paraparesis. Imaging studies revealed refracture at T12 and a new compression fracture at T11. The SC was severely compressed by the fracture fragment. The patient underwent anterior corpectomy of T12, removal of bone cement and fracture fragment, anterior interbody fusion, and pedicle screw fixation. In the present case, it is thought that an uneven distribution of bone cement with a solid lump pattern and excessive restoration of vertebral body height and kyphotic angle might have increased the risk of refracture of the cemented vertebra. These points should be avoided during VP or KP, especially when an IVC is present.