Anesth Pain Med.  2016 Jan;11(1):80-84. 10.17085/apm.2016.11.1.80.

Vertebroplasty of compression fracture with prevertebral hematoma during treatment of postherpetic neuralgia: A case report

• Lee KH
• Park JH
• Do HJ
• Kim C
• Han KR

• KMID: 2169080
• DOI: http://doi.org/10.17085/apm.2016.11.1.80

Abstract

Postherpetic neuralgia (PHN) and vertebral compression fracture (VCF) are common causes of chronic pain in the elderly population. Careful history taking and imaging studies are needed for diagnosis when both diseases coexist. Vertebroplasty is a clinically efficient surgical treatment of VCF, while nerve block and/or medications are the mainstay of PHN pain control. The most serious complications of vertebroplasty are pulmonary embolism or neurologic deficit due to cement leakage. An 80-year-old female patient was diagnosed with PHN of the right L1 dermatome; however, her pain expanded to the midback and subcostal area. Thoracic magnetic resonance imaging and abdominal computed tomography revealed recent L2 compression fracture with prevertebral hematoma caused by cortical bone defect of the L2 body. Even though the risk of cement leakage was high, L2 vertebral body augmentation was performed using a bone filler device and high-viscosity cement; this treatment was successful, without cement leakage or any other complications.

Keyword

Bone cements; Compression fracture; Neuralgia; Postherpetic; Spine; Vertebroplasty

MeSH Terms

Aged
Aged, 80 and over
Bone Cements
Chronic Pain
Diagnosis
Female
Fractures, Compression*
Hematoma*
Humans
Magnetic Resonance Imaging
Nerve Block
Neuralgia
Neuralgia, Postherpetic*
Neurologic Manifestations
Pulmonary Embolism
Spine
Vertebroplasty*
Bone Cements

Figure

• 

  Fig. 1 Anteroposterior and lateral radiographs before (A, B) and after (C, D) vertebroplasty of the L2 vertebral body. (A and B) show T12 and L2 compression fracture with intravertebral vacuum of L2 body. (C and D) show bone cement fills the fractured vertebra without leakage.

• 

  Fig. 2 Thoracic spine-MRI shows recent L2 compression fracture (arrow) with intravertebral vacuum and paravertebral hematoma (arrow head) with an 8.3 × 3 × 2.6-cm heterogeneous signal intensity in the prevertebral area adjacent to the abdominal aorta between T12 and L2. (A) T1-weighted sagittal image, (B) T2-weighted sagittal image, (C) T1-weighted axial image at the L1 level, (D) T2-weighted axial image at the L1 level.

• 

  Fig. 3 (A) Abdominal CT reveals a prevertebral nonenhancing soft tissue mass with heterogeneous density and intralesional multiple gas shadow between the inferior vena cava and the proximal abdominal aorta (arrow head) at the upper L1 level. (B) Intravertebral vacuum of L2 with cortical breakage (arrow) at the anteroinferior corner.

• 

  Fig. 4 Parts for bone filler instrument.

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