게시판
| 21KS-028 |
Iatrogenic vertebral fractures after percutaneous lumbar foraminoplasty : A case report
Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
[Background]
Percutaneous lumbar foraminoplasty(PLF) is a procedure to widen a stenotic intervertebral foramen using a drill specially designed to grind and remove adhesive tissues around affected nerve roots. Like any surgeries or procedures, PLF can result in some complications such as bleeding, infections, iatrogenic nerve injuries, etc. Here, we reported a rare complication after PLF.
[Cases]
A 76-year old man with chronic back pain visited our clinic. He also suffered radiating pain towards both legs. Surgery including decompressive total laminectomy(L2-3-4-5) had been done before his visit, but symptoms still persisted. L-spine MRI showed extensive central and foraminal spinal stenosis from L2 to L5 with markedly decreased disc spaces and degenerative changes. Various treatments including steroid epidural injection, percutaneous epidural neuroplasty were found to be ineffective. So we decided to perform PLF on both sides(L2-3,L3-4,L5-S1,Rt./L4-5,L5-S1,Lt.). After the procedures, radiating pain to both legs relieved but back pain worsened with a squeezing nature. Followed L-spine MRI showed newly formed fracture lines in L4 and L5 vertebral body compared to previous MRI.
[Conclusion]
PLF can cause traumatic vertebral fractures as forceful impacts between bony structures of the spine and the instruments possibly occur during the procedure. Most affected sites involve vertebral body and superior articular process. And this traumatic injury seems to occur more frequently in osteoporotic patients. Thus, more cautions should be made during the procedure in these populations. Subsequent studies are required to identify risk factors related to vertebral fractures during PLF.
[References]
Yoo, Yongjae et al, Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis, Medicine: April 2019 - Volume 98 - Issue 15 - p e15169
Percutaneous lumbar foraminoplasty(PLF) is a procedure to widen a stenotic intervertebral foramen using a drill specially designed to grind and remove adhesive tissues around affected nerve roots. Like any surgeries or procedures, PLF can result in some complications such as bleeding, infections, iatrogenic nerve injuries, etc. Here, we reported a rare complication after PLF.
[Cases]
A 76-year old man with chronic back pain visited our clinic. He also suffered radiating pain towards both legs. Surgery including decompressive total laminectomy(L2-3-4-5) had been done before his visit, but symptoms still persisted. L-spine MRI showed extensive central and foraminal spinal stenosis from L2 to L5 with markedly decreased disc spaces and degenerative changes. Various treatments including steroid epidural injection, percutaneous epidural neuroplasty were found to be ineffective. So we decided to perform PLF on both sides(L2-3,L3-4,L5-S1,Rt./L4-5,L5-S1,Lt.). After the procedures, radiating pain to both legs relieved but back pain worsened with a squeezing nature. Followed L-spine MRI showed newly formed fracture lines in L4 and L5 vertebral body compared to previous MRI.
[Conclusion]
PLF can cause traumatic vertebral fractures as forceful impacts between bony structures of the spine and the instruments possibly occur during the procedure. Most affected sites involve vertebral body and superior articular process. And this traumatic injury seems to occur more frequently in osteoporotic patients. Thus, more cautions should be made during the procedure in these populations. Subsequent studies are required to identify risk factors related to vertebral fractures during PLF.
[References]
Yoo, Yongjae et al, Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis, Medicine: April 2019 - Volume 98 - Issue 15 - p e15169
