Failed Percutaneous Vertebroplasty Due to Insufficient Correction of Intravertebral Instability in Kummell's Disease: A Case Report

Jung Eun Kim, Sang Sik Choi, Mi Kyoung Lee, Dong Kyu Lee, Seung Inn Cho

    Research output: Contribution to journalArticlepeer-review

    8 Citations (Scopus)

    Abstract

    Kummell's disease, caused by osteonecrosis of the vertebral body, is a cause of vertebral collapse. In Kummell's disease, intravertebral instability from nonunion between the cement and bone after percutaneous vertebroplasty (PVP) can cause persistent severe pain and dysfunction. A 75-year-old woman presented with severe pain in the lower back, both buttocks, groin, and both posterior thighs for a period of 30 days. Lumbar radiographs and magnetic resonance images showed an acute compression fracture of the first lumbar vertebra with an intravertebral cleft filled with fluid. The patient underwent PVP for the L1 compression fracture; however, this failed to provide sufficient pain relief. The patient was re-evaluated with dynamic radiography, and intravertebral instability and bone cement displacement of the L1 vertebra were detected. Repeat PVP was performed. After the procedure, intravertebral instability was restored and her pain completely subsided. PVP is a good treatment choice for symptomatic Kummell's disease. However, there is no consensus on the best technique of injecting bone cement to achieve optimal results. It is important to inject more bone cement than the volume of the intravertebral cleft to prevent instability caused by nonunion in PVP for Kummell's disease. We report a case of failed PVP because of insufficient correction of intravertebral instability in Kummell's, along with a review of the literature.

    Original languageEnglish
    Pages (from-to)1109-1114
    Number of pages6
    JournalPain Practice
    Volume17
    Issue number8
    DOIs
    Publication statusPublished - 2017 Nov 1

    Keywords

    • intravertebral instability
    • intravertebral vacuum cleft
    • Kummell's disease
    • nonunion
    • percutaneous vertebroplasty
    • vertebral compression fracture

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine

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