Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture: a report of two cases

Abstract

PurposeTo describe two unique cases of osteoporotic vertebral compression fracture (OVCF) treated with balloon kyphoplasty (BKP) that were complicated by spinal instability and resultant lower extremity paraparesis.MethodsKyphoplasty was performed in two patients with OVCF that had persistent back pain despite a course of conservative care. Immediately following BKP, both patients had a marked improvement in back pain. However, they developed progressive bilateral lower extremity weakness. Lateral spine flexion–extension radiographs demonstrated instability, and polymethyl methacrylate did not adhere to the endplate of the treated vertebrae.ResultsBoth the patients underwent a hybrid fixation without a decompression. Postoperatively, both of them demonstrated gradual improvement in their neurological exam.ConclusionsTo the best of our knowledge, this is the first report describing the development of spinal instability with resultant delayed paraplegia following BKP. This case report demonstrates another cause of neurological decline following BKP, in the absence of cement leakage.

Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

“…Recently, interest has increased in the mortality and morbidity of patients who undergo spinal surgery [ 18 , 19 ]. Additionally, numerous reports have surfaced for comparative studies of surgical procedures for OVF; these have focused on surgical invasiveness and complications [ 20 ]. By contrast, the postoperative outcome of pain and survival of patients with an insufficient bony union after OVF surgery remains largely unknown.…”

Does an osteoporotic vertebral fracture treated by balloon kyphoplasty successfully achieve bone union during the follow-up? A retrospective study with a minimum 2-year follow-up

“…11 Furthermore, paraparesis has been reported to occur due to instability after BKP. 12 We also observed one case with delayed palsy after BKP in our institution that needed additional decompression and fusion surgery. In other words, the instability that occurs because of the OVF remains after BKP (Fig.…”

“…Past literature previously reported that instability remains after balloon kyphoplasty. 10 Ohba et al 12 reported that instability of the treated vertebrae after balloon kyphoplasty caused paraparesis. In addition, Kim et al 11 reported that the incidence of recompression in treated vertebrae was 12.5%.…”

Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

“…[18,19] Additionally, numerous reports have surfaced for comparative studies of surgical procedures for OVF; these have focused on surgical invasiveness and complications. [20] By contrast, the postoperative outcome of pain and survival of patients with an insu cient bony union after OVF surgery remains largely unknown. Although the present study showed that the VAS scores for both the lumbar spine and leg were signi cantly improved one year after surgery compared to scores at the time of hospital admission, those scores may not be meaningful clinically.…”