Skip to main content
SpringerLink
Log in

Postoperative aseptic osteonecrosis in a case of kyphoplasty

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Aseptic osteonecrosis appears to be an infrequent adverse event after kyphoplasty which has not previously been reported. In the following, we present the case of a 73-year-old female who sustained a compression fracture of the first lumbar vertebra (L1) in a motor vehicle accident. The fracture was treated by kyphoplasty using PMMA cement. Three weeks after hospital discharge the patient was presented with increasing back pain. In imaging, dislocation of the PMMA cement could be shown combined with a total collapse of the L1 vertebra. The resulting significant kyphosis was first reduced by dorsal transpedicular (Th12–L2) internal fixation and stabilized by an anterior cage after total removal of the cement plomb and some remaining bone of the L1 vertebra. Bacterial as well as histological examination of the cement and bone led to the diagnosis of aseptic osteonecrosis. Different underlying events could be discussed. We think it most likely that the osteoporotic bone was unable to interface sufficiently with the PMMA cement and, therefore, disintegrated under loading. Furthermore, the volume of injected cement could have significantly compromised the blood supply within the bone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Belkoff SM, Mathis JM, Jasper LE, Deramond H (2000) The biomechanics of vertebroplasty.The effect of cement volume on mechanical behaviour. Spine 26:1537–1541. doi:10.1097/00007632-200107150-00007

    Article  Google Scholar 

  2. Cooper C, Atkinson EJ, Jacobsen SJ, O`Fallon M, Melton LJ (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005

    PubMed  CAS  Google Scholar 

  3. Cortet B, Cotton A, Boutry N et al (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26(10):2222–2228

    PubMed  CAS  Google Scholar 

  4. Cotton A, Dewatre F, Cortet B et al (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 200:525–530

    Google Scholar 

  5. Dahl OE, Darvic LJ, Lyberg T (1994) Toxic effects of methylmethacrylate monomer on leucocytes and endothelial cells in vitro. Acta Orthop Scand 65(2):147–153

    Article  PubMed  CAS  Google Scholar 

  6. Deramond H, Wright NT, Belkoff SM (1999) Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 25(Suppl 2):17–21. doi:10.1016/S8756-3282(99)00127-1

    Article  Google Scholar 

  7. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine. Spine 26:1511–1515. doi:10.1097/00007632-200107150-00002

    Article  PubMed  CAS  Google Scholar 

  8. Garfin SR, Lin G, Lieberman I, Phillips F, Truumees E (2001) Retrospective analysis of the outcomes of balloon kyphoplasty to treat vertebral body compression fracture refractory to medical management. Eur Spine J 10:S7–S8 Abstract

    Google Scholar 

  9. Garfin SR, Hansen A, Yuan HA et al (2001) Kyphoplasty and vertebroplasty for treatment of painful osteoporotic compression fractures. Spine 26(14):1511–1515. doi:10.1097/00007632-200107150-00002

    Article  PubMed  CAS  Google Scholar 

  10. Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older woman. Arch Intern Med 159:1215–1220. doi:10.1001/archinte.159.11.1215

    Article  PubMed  CAS  Google Scholar 

  11. Lieberman IH, Dudeney S, Reinhardt MK et al (2001) Initial outcome and efficary of kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Spine 26(14):1631–1638. doi:10.1097/00007632-200107150-00026

    Article  PubMed  CAS  Google Scholar 

  12. Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroblasty. Spine 26:1547–1554. doi:10.1097/00007632-200107150-00009

    Article  PubMed  CAS  Google Scholar 

  13. Schlaich C, Minne HW, Bruckner T et al (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8(3):261–267. doi:10.1007/s001980050063

    Article  PubMed  CAS  Google Scholar 

  14. Togawa D, Bauer T, Lieberman IH, Takikawa S (2003) Histologic evaluation of human vertebral bodies after vertebral augmentation with polymethyl methacrylate. Spine 28(14):1521–1527. doi:10.1097/00007632-200307150-00009

    Article  PubMed  Google Scholar 

  15. Wilke HJ, Mehnert U, Claes LE, Bierschneider MM, Jaksche H, Boszczyk BM (2006) Biomechanical evaluation of vertebroplasty and kyphoplasty with polymethyl methacrylate or calcium phosphate cement under cyclic loading. Spine 31(25):2934–2941. doi:10.1097/01.brs.0000248423.28511.44

    Article  PubMed  Google Scholar 

  16. Wong W, Reiley MA, Garfin S (2000) Vertebroplasty/kyphoplasty. J Womens Imaging 2:117–124

    Google Scholar 

Download references

Conflict of interest statement

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Trauma, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105, Kiel, Germany

    Michael Mueller, M. Daniels-Wredenhagen, L. Besch & A. Seekamp

  2. Operatives Zentrum, Klinik Dr. Winkler, Brückmanstr. 6, 25813, Husum, Germany

    C. Decher

Authors
  1. Michael Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Daniels-Wredenhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Besch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Decher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Seekamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Mueller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mueller, M., Daniels-Wredenhagen, M., Besch, L. et al. Postoperative aseptic osteonecrosis in a case of kyphoplasty. Eur Spine J 18 (Suppl 2), 213–216 (2009). https://doi.org/10.1007/s00586-008-0843-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-008-0843-2

Keywords

Search

Navigation