Vertebral fracture treated with kyphoplasty: case review

The following set of images outlines one patient's experience with the use of kyphoplasty to treat a vertebral compression fracture.

Initial diagnosis
After this 78 year-old man slipped and fell while at home, he complained of mid-back pain. A lateral (side view) x-ray was taken, which showed a compression fracture of the L1 vertebra (see Figure 1). He was initially treated with pain medication and a removable back brace.  

Continued pain
Six weeks later, the patient was experiencing continued pain that limited his ability to do everyday activities. A new x-ray was taken that showed increased collapse of the front of the L1 vertebra (see Figure 2), creating wedging of the vertebra and causing the patient to stand leaning forward.

Surgical planning
To help plan the treatment, it was important to also view the back of the vertebra to see if there was any damage. Cement fixation via vertebroplasty or kyphoplasty is considerably less safe in cases where the back of the vertebral body is also fractured, because of the increase in the chance of leakage of cement into the spinal nerve canal. Therefore, a CT scan image of the fractured L1 vertebra was taken (see Figure 3), which in this case showed no such breaks in the back of the vertebral body.  

It was decided to proceed with kyphoplasty, with the goal of alleviating the patient's pain and restoring the height of the vertebra (to reduce the wedge shape) so that the patient would be able to stand upright.

Postoperative images
Following the kyphoplasty procedure, x-ray images of the L1 vertebra were taken. The lateral (side view) x-ray showed restoration of the height of the front of the L1 vertebra to its original fracture height before the additional collapse (see Figure 4). Likewise, the anteroposterior (front view) x-ray following the kyphoplasty also shows restoration of the L1 vertebra (see Figure 5).

The whitened areas shown in the x-rays are the cement that was injected into the bone after elevation of the collapsed vertebra with the inflatable balloon.

Jeffrey Spivak, MD
November 17, 2003