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Facet Pain Following Vertebroplasty for Chronic Compression Fracture 2007

Interventional Spine

Serge Menkin, MD

Excerpta Extraordinaire

Excerpta

A 60 year-old female presented to our office with 17 month history of thoracolumbar junction pain following a fall. The pain was present with sitting, standing, walking. Nuclear bone scan which was done 2 months after the fall showed increased uptake in the left lateral aspect of the T12 vertebral body. The pain was refractory to anti-inflammatory medication, pain medication, physical therapy and one lumbar epidural. She was severely debilitated by her pain. She rated the pain as 7/10 on VAS. A new MRI revealed chronic compression fracture of T12 vertebral body.

The patient underwent T12 vertebroplasty via unipedicular approach with preferential PMMA placement on the left aspect of the vertebral body. After the procedure the patient had complete resolution of her symptoms at thoracolumbar junction. However, in 20 weeks following the vertebroplasty the thoracolumbar pain returned. The character of pain was different than prior to vertebroplasty. The pain was less severe and it was absent on sitting, but present with standing and walking. Repeat imaging, including the plain X-rays and MRI did not reveal any adjacent level fractures. The patient underwent right side injections of T11-T12, T12-L1 facets with 80% improvement in pain.

Most of the literature describing biomechanical changes following the vertebroplasty indicates increased stresses around the endplate of the adjacent vertebra. This case illustrates that at the facets may be affected by the increased loads in a setting of vertebral augmentation of the chronic compression fracture. This may have resulted from the correction of the segmental lordosis which had developed as a compensation for vertebral kyphosis.

References

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Baroud G, Bohner M. Biomechanical impact of vertebroplasty. Joint Bone Spine 2006;73:144-50