Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty

An unusual case of recurrent traumatic spinal epidural hematoma accompanied by osteoporotic vertebral compression fractures: Case report

RATIONALE

Traumatic spinal epidural hematoma (SEH) is a rare clinical condition. Here, we present an extraordinary case of recurrent SEH accompanied by thoracolumbar spine fractures resulting from minor trauma, and provide evidence-based recommendations for the surgical management strategies in this unique scenario.

PATIENT CONCERNS

A 71-year-old female patient presented with back pain after a fall. Magnetic resonance imaging revealed an SEH with L2 vertebral compression fracture. Following unsuccessful conservative treatment, percutaneous vertebroplasty was performed at the 2nd lumbar vertebra under local anesthesia. Two years later, the patient experienced another fall and was diagnosed with spinal hematoma with L1 vertebral compression fractures.

DIAGNOSES

The patient was diagnosed with recurrent osteoporotic vertebral compression fracture accompanying SEH.

OUTCOMES

After 1 week of conservative treatment, notable improvement of limbs numbness was observed. The patient ultimately underwent L1 vertebroplasty surgery. The patient was discharged smoothly on the third postoperative day and made a full recovery after 4 months.

LESSONS

SEH is a rare clinical finding that can occur even after a minor trauma in the elderly. It is worth noting that osteoporotic vertebral compression fractures with asymptomatic or stable intraspinal hematoma, is not considered to be a contraindication for percutaneous vertebroplasty. And percutaneous vertebroplasty is a safe and effective treatment for osteoporotic compression fractures with asymptomatic SEH.

Percutaneous vertebroplasty in osteoporotic vertebral compression fracture with huge spinal epidural hematoma: A case report

RATIONALE

Osteoporotic vertebral compression fracture (OVCF) accompanying huge spinal epidural hematoma (SEH) is fairly rare. The aim of this report is to investigate the management strategies and treatment outcomes of OVCF accompanying SEH.

PATIENT CONCERNS

An 89-year-old female patient was admitted to hospital because of severe back pain and numbness of both lower limbs after a slight fall. The magnetic resonance imaging examination of the patient showed a fresh compression fracture at L2 accompanying a large dorsal SEH which extended from the T12 to L3 and deformed the spinal cord.

DIAGNOSIS

The patient was diagnosed with OVCF accompanying SEH.

INTERVENTIONS

Given mild neurologic deficits, the hematoma was not treated, and the patient underwent percutaneous vertebroplasty (PVP) only.

OUTCOMES

After the procedure, immediate pain relief was achieved and the numbness of both lower limbs disappeared 3 days later. Three months after the procedure, the follow-up magnetic resonance imaging revealed a complete resolution of the hematoma.

LESSONS

OVCF accompanying SEH is fairly rare, and the exact pathophysiological mechanisms are still not clear. In selected patients without or with only slight neurologic symptoms, it is reasonable to perform PVP alone in OVCF accompanying SEH. Moreover, intravertebral stability after PVP might have played a role in spontaneous resolution of SEH.

Outcomes of different minimally invasive surgical treatments for vertebral compression fractures: An observational study

BACKGROUND

Osteoporosis with vertebral compression fractures is increasingly common in the elderly population. Cement augmentation is one of the effective surgical treatments for these patients. Currently, there are several different types of cement augmentation treatments. No studies have compared the safety and efficacy of different cement augmentation types for the treatment of such fractures; thus, we retrospectively compared vertebroplasty, balloon kyphoplasty, and kyphoplasty with SpineJack or an intravertebral expandable pillar.

AIM

To compare the postoperative safety and efficacy of each surgical intervention in treating vertebral compression fractures.

METHODS

We retrospectively analyzed 354 patients with acute vertebral compression fractures, defined as signal changes in the T1 weighted magnetic resonance imaging, and randomly divided the patients into five groups. Their visual analog scale scores for pain, kyphotic angle, average body height, rate of cement leakage, and occurrence of adjacent vertebral compression fractures were followed for 1 year. One-way analysis of variance, the post hoc Bonferroni test, and Fisher exact probability test were used for statistical analyses.

RESULTS

All pain scores significantly improved 12 mo postoperatively; however, there was no significant difference between the groups (P = 0.325). Kyphoplasty with SpineJack significantly reduced the kyphotic angle (P = 0.028) and restored the height of the vertebral body (P = 0.02). The rate of adjacent compression fractures was the highest in the vertebroplasty group, with a statistically significant difference according to the Fisher exact probability test (P = 0.02). The treatment with the lowest cement leakage rate cannot be identified because of the small sample size; however, kyphoplasty with SpineJack, an IVEP, and vesselplasty resulted in lower rates of cement leakage than balloon kyphoplasty and vertebroplasty.

CONCLUSION

Kyphoplasty with SpineJack has good outcomes in kyphotic angle reduction and body height restoration. Vertebroplasty has the highest cement leakage rate and adjacent compression fracture occurrence.

Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins-osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues-20%; paravertebral vein embolism-13%; intradiscal leakage-8%; and PMMA leakage into the spinal canal-0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient-with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.

Percutaneous vertebroplasty of the entire thoracic and lumbar vertebrae for vertebral compression fractures related to chronic glucocorticosteriod use: case report and review of literature

Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.