Simultaneous-onset infectious spondylitis with vertebral fracture mimicking an acute osteoporotic vertebral fracture erroneously treated with balloon kyphoplasty: illustrative case.

Autor:	Yonezawa N; Department of Orthopaedic Surgery, Saiseikai Kanazawa Hospital, Kanazawa, Japan., Tokuumi Y; Department of Orthopaedic Surgery, Asanogawa General Hospital, Kanazawa, Japan., Komine N; Department of Orthopaedic Surgery, Asanogawa General Hospital, Kanazawa, Japan., Uto T; Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan., Toribatake Y; Department of Orthopaedic Surgery, Kouseiren Takaoka Hospital, Takaoka, Japan., Murakami H; Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan; and., Demura S; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan., Tsuchiya H; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2021 Sep 20; Vol. 2 (12), pp. CASE2135. Date of Electronic Publication: 2021 Sep 20 (Print Publication: 2021).
DOI:	10.3171/CASE2135
Abstrakt:	Background: Early balloon kyphoplasty (BKP) intervention for acute osteoporotic vertebral fracture (OVF) has been reported to be more effective than the conservative treatment. However, complications of early BKP intervention are still unknown. Observations: A 71-year-old patient with OVF of L2 underwent BKP 2 weeks after symptom onset. Preoperative magnetic resonance imaging (MRI) and radiograph were compatible with new L2 OVF. Although computed tomography (CT) images revealed the atypical destruction of lower endplate of L2 as OVF, L2 BKP was planned. After BKP, his back pain improved dramatically. Two weeks after BKP, his lower back pain recurred. MRI and CT confirmed the diagnosis of infectious spondylitis with paravertebral abscess formation. With adequate antibiotic treatment and rehabilitation, he was symptom-free and completely ambulatory without signs of infection. Lessons: Signal changes on the fractured vertebral bodies during initial MRI and fractured vertebral instability on radiograph can mislead the surgeon to interpret the infection as a benign compression fracture. If the patients exhibit unusual destruction of the endplate on CT imaging, "simultaneous-onset" spondylitis with vertebral fracture should be included in the differential diagnosis. To determine the strategy for OVF, preoperative biopsy is recommended if simultaneous-onset spondylitis with vertebral fracture is suspected. Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. (© 2021 The authors.)
Databáze:	MEDLINE
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