Percutaneous Vertebroplasty of Vertebra Plana

Introduction:

Percutaneous vertebroplasty and spinal traction were combined to treat successfully a fully collapsed vertebral compression fracture.

Methods:

A 77 year–old female presented with severe chronic pain from a T12 compression fracture, which had progressed from approximately 50% to 80% compression over a 12 week period. Retropulsion of the posterior vertebra produced spinal canal compromise with mild compression of the conus medullaris. Her neurologic exam was remarkable for mild bilateral foot drop and brisk deep tendon reflexes. The patient was felt to be a poor candidate for corpectomy and fusion. Plain film radiographs and MRI demonstrated a central vertebral vacuum phenomenon suggesting that the endplates were not fused. Radiographs obtained during spinal traction demonstrated approximately 1.5 cm of distraction of the endplates. Percutaneous vertebroplasty was performed via a unilateral transpedicular approach. Injection of 5 mL polymethyl–methacrylate cement filled the central vertebral cavity.

Results:

Post treatment MRI revealed approximately 1.3 cm of vertebral height restoration. The degree of spinal canal compromise had not changed. The patients' pain increased over the next 48 hours and then resolved to a minimal level over the next week. Her pain had resolved and her neurologic exam was stable at 6–week follow–up.

Discussion and Conclusion:

Percutaneous vertebroplasty has been considered technically impossible when very severe vertebral compression has occurred. In some cases, spinal traction or hyperextension may demonstrate that vertebroplasty may be performed successfully.