Advertisement

European Spine Journal

, Volume 14, Issue 9, pp 895–899 | Cite as

Spondylitis following vertebroplasty: a case report

  • Katharina E. SchmidEmail author
  • Bronek M. Boszczyk
  • Michael Bierschneider
  • Andreas Zarfl
  • Björn Robert
  • Hans Jaksche
Case Report

Abstract

Purpose: Spondylitis is a rare complication of vertebroplasty with only one case report having been published to date. We report a further case of spondylitis after vertebroplasty that was managed successfully with conservative therapy. Methods: The clinical course of a 55-year-old patient with secondary osteoporosis due to liver cirrhosis from alcohol abuse is reported, in whom percutaneous vertebroplasty of three fractured vertebral bodies (L3–L5) was complicated by spondylitis at these levels. Results: Spondylitis of L3–L5 with paravertebral abscess formation and progressive collapse of L5 was detected by magnetic resonance imaging (MRI). Treatment consisted of percutaneous aspiration of the paravertebral abscess and antibiotic therapy. No bacteria was identified despite cultures have been taken before antibiotic treatment. The patient was treated with intravenous ciprofloxacin and consecutive clindamycin for a total of 3 months. One year after the infection the MRI signs of spondylitis have resolved without further collapse of L5. Painlevels have improved significantly, allowing the patient to return to work, but are still higher than immediately after vertebroplasty. Conclusion: Spondylitis is a rare complication of vertebroplasty. In the presented case a satisfactory result could be achieved through conservative antibiotic therapy and restriction of movement.

Keywords

Vertebroplasty Complications Spondylitis Conservative therapy Further vertebral collapse 

References

  1. 1.
    Al-Assir I, Perez-Higueras A, Florensa J, Munoz A, Cuesta E (2000) Percutaneous vertebroplasty: a special syringe for cement injection. Am J Neuroradiol 21:159–161PubMedGoogle Scholar
  2. 2.
    Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 8:923–928CrossRefGoogle Scholar
  3. 3.
    Berlemann U, Heini PF (2002) Perkutane Zementierungstechniken zur Behandlung osteoporotischer Wirbelkörpersinterungen. Unfallchirurg 105:2–8CrossRefPubMedGoogle Scholar
  4. 4.
    Bernhard J, Heini PF, Villinger PM (2003) Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty. Ann Rheum Dis 62:85–86CrossRefPubMedGoogle Scholar
  5. 5.
    Bong-Jin L, Sung-Rak L, Tae-Yeul Y (2002) Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate. Spine 19:419–422Google Scholar
  6. 6.
    Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH, Wu CT (2002) A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 95:1060–1062CrossRefPubMedGoogle Scholar
  7. 7.
    Cortet B, Cotton A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26:2222–2228PubMedGoogle Scholar
  8. 8.
    Cotton A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200:525–530PubMedGoogle Scholar
  9. 9.
    Debussche-Depriester C, Deramond H, Fardellone P, Heleg A, Sebert JL, Cartz L, Galibert P (1991) Percutaneous vertebroplasty with acrylic cement in the treatment of osteoporotic vertebral crush fracture syndrome. Neuroradiology 33(Suppl):149–152CrossRefPubMedGoogle Scholar
  10. 10.
    Garfin SR, Yuan HA, Reiley MA (2001) New Technologies in Spine: Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 14:1511–1515CrossRefGoogle Scholar
  11. 11.
    Gelb H, Schumacher HR, Cuckler J, Baker DG (1994) In vivo inflammatory response to polymethylmethacrylate particulate debris: effect of size, morphology and surface area. J Orthop Res 12:83–92CrossRefPubMedGoogle Scholar
  12. 12.
    Hardouin P, Fayada P, Leclet H, Chopin D (2002) Review: kyphoplasty. Joint Bone Spine 69:256–261CrossRefPubMedGoogle Scholar
  13. 13.
    Harrington KD (2001) Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate. A case report. J Bone Joint Surg 7:1070–1073Google Scholar
  14. 14.
    Heini PF, Wälchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. Eur Spine J 9:445–450CrossRefPubMedGoogle Scholar
  15. 15.
    Jang JS, Lee SH, Jung SK (2002) Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty. A report of three cases. Spine 19:416–418CrossRefGoogle Scholar
  16. 16.
    Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. Am J Neuroradiol 18:1897–1904PubMedGoogle Scholar
  17. 17.
    Konno S, Olmarker K, Byröd G, Nordborg C, Strömqvist B, Rydevik B (1994) Acute thermal nerve root injury. Eur Spine J 3:299–302PubMedGoogle Scholar
  18. 18.
    Kraus GJ, Achatz W, Görzer HG (2003) Becken- und Beinvenenthrombose als Komplikation der perkutanen Vertebroplastie. Fortschr Röntgenstr 175:565–566CrossRefGoogle Scholar
  19. 19.
    Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of ”Kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 14:1631–1638CrossRefGoogle Scholar
  20. 20.
    Lin JT, Lane JM (2002) Nonmedical management of osteoporosis. Rheumatology 14:441–446Google Scholar
  21. 21.
    Martin JB, Jean B, Sugiu K, San Millan Ruiz D, Piotin M, Murphy K, Rüfenacht B, Muster M, Rüfenacht DA (1999) Vertebroplasty: clinical experience and follow-up results. Bone 2 (Suppl):11–15CrossRefGoogle Scholar
  22. 22.
    Padovani B, Kasriel O, Brunner P, Peretti-Viton P (1999) Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. Am J Neuroradiol 20:375–377PubMedGoogle Scholar
  23. 23.
    Perez-Higueras A, Alvarez L, Rossi RE, Quinones D, Al-Assir I (2002) Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology 44:950–954CrossRefPubMedGoogle Scholar
  24. 24.
    Perrin C, Jullien V, Padovani B, Blaive B (1999) Une vertebroplastie percutanee compliquee d’une embolie pulmonaire de ciment acrylique. Rev Mal Respir 16:215–217PubMedGoogle Scholar
  25. 25.
    Prymka M, Pühler T, Hirt S, Ulrich HW (2003) Extrakorporaler Zementabfluss mit Füllung des extraduralen Venenplexus bis in die V. cava nach Vertebroplastie. Unfallchirurg 106:860–864CrossRefPubMedGoogle Scholar
  26. 26.
    Ratliff J, Nguyen T, Heiss J (2001) Root and spinal cord compression from methylmethacrylate vertebroplasty. Spine 13:300–302CrossRefGoogle Scholar
  27. 27.
    Ryu KS, Park CK, Kim MC, Kang JK (2002) Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg (Spine1) 96:56–61Google Scholar
  28. 28.
    Scroop R, Eskridge J, Britz GW (2002) paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report. AJNR 23:868–870PubMedGoogle Scholar
  29. 29.
    Szpalski M, Gunzburg R, Deramond H (2003) Percutaneous injection of cortoss synthetic bone void filler in the repair of fractures in the vertebral body. In: Szpalski M, Gunzburg R, Deramond H (eds) Vertebral osteoporotic compression fractures. Lipincott Williams Wilkins, Philadelphia, pp 171–178Google Scholar
  30. 30.
    Tozzi P, Abdelmoumene Y, Corno AF, Gersbach PA, Hoogewoud HM, von Segesser LK (2002) Management of pulmonary embolism during acrylic vertebroplasty. Ann Thorac Surg 74:1706–1708PubMedGoogle Scholar
  31. 31.
    Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Chol IS (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124Google Scholar
  32. 32.
    Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E (1996) Spinal metastases: Indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199:241–247Google Scholar
  33. 33.
    Wenger M, Markwalder TM (1999) Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroskopic guidance. Acta Neurochir 141:625–631CrossRefGoogle Scholar
  34. 34.
    Wong W, Reiley MA, Garfin S (2000) Vertebroplasty/Kyphoplasty. J Women’s Imaging 3:117–124Google Scholar
  35. 35.
    Yu SW, Chen WJ, Lin WC, Chen YJ, Tu YK (2004) Serious pyogenic spondylitis following vertebroplasty—a case report. Spine 29:209–211CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Katharina E. Schmid
    • 1
    Email author
  • Bronek M. Boszczyk
    • 2
  • Michael Bierschneider
    • 1
  • Andreas Zarfl
    • 3
  • Björn Robert
    • 1
  • Hans Jaksche
    • 1
  1. 1.Department of NeurosurgeryBerufsgenossenschaftliche Unfallklinik MurnauMurnauGermany
  2. 2.Spine Service, Department of Orthopaedic Surgery, InselspitalUniversitätsspital BernSwitzerland
  3. 3.Department of RadiologyBerufsgenossenschaftliche Unfallklinik MurnauMurnauGermany

Personalised recommendations