J Korean Soc Spine Surg.  2013 Jun;20(2):58-63. 10.4184/jkss.2013.20.2.58.

Spontaneous Compression Fracture on the Instrumented End Vertebra: A Case Report

• Kim HS
• Kim HS
• Park YS

• KMID: 1430376
• DOI: http://doi.org/10.4184/jkss.2013.20.2.58

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
This case report presents an elderly male who sustained compression fractures twice on the instrumented end vertebra following a spinal fusion with pedicle screws. SUMMARY OF LITERATURE REVIEW: Because of its low incidence, there is considerable debate regarding an optimal treatment of adjacent segment fracture after long lumbar fusion. Almost all of the reports about adjacent segment fracture are about adjacent vertebral fractures rather than the instrumented vertebral fractures.
MATERIALS AND METHODS
A 69 year-old male who was admitted with low back pains of no apparent physical injury underwent pedicle subtraction osteotomy and posterolateral fusion for L3 vertebral fracture and post-traumatic kyphosis. Extension of the fusion segment was performed two months after the initial operation to correct his compression fracture of the instrumented end vertebra, followed by conservative treatments due to a second compression fracture of the instrumented end vertebra two months after the second surgery.
RESULTS
Conservative treatment was performed with TLSO brace, after which the fracture was gradually stabilized.
CONCLUSIONS
Further research via additional case studies is required to better understand its cause and to develop effective treatment options.

Keyword

The instrumented end vertebra; Vertebral compression fracture

MeSH Terms

Aged
Braces
Fractures, Compression
Humans
Incidence
Kyphosis
Low Back Pain
Male
Osteotomy
Spinal Fusion
Spine

Figure

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  Fig. 1. (A) Preoperative lateral entire spine x-rays demonstrating a collapse of the L3 vertebral body and kyphosis. (B) Computed tomography revealing a canal involvement(50%) of the posterior fragment. (C) MRI views showing acute L3 vertebral fracture with high signal intensity and the dural sac compression.

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  Fig. 2. Postoperative (A), 1 month (B) and 2 months (C) lateral x-rays after 1st operation showing a progression of L1 fracture.

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  Fig. 3. Postoperative (A), 1 month (B) and 9 months (C) lateral x-rays after 2nd operation showing a progression of T10 fracture.

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