Article
Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report
Nicomedes Fernández-Baíllo, José M Sánchez Márquez*, Francisco J Sánchez Pérez-Grueso and Alfredo García Fernández * Corresponding author: José M Sánchez Márquez
jm.sanchez.marquez@
gmail.com
Orthopedic Surgery Department, Spine Service, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
Scoliosis 2012, 7:16 doi:10.1186/1748-7161-7-16 © 2012 Fernández-Baíllo et al.; licensee BioMed Central Ltd.
Abstract
Background To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level.
Methods
This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesised.
Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the “topping- off syndrome”.
Thirty days after discharge, without recognisable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed
overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw.
At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowl- edge, this is an unreported fracture.
Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation.
Keywords Adult deformity; Proximal junctional fracture; Vertebroplasty
Background
Adjacent segment problems are well docu- mented after spinal fusion. In osteoporotic patients with decreased bone strength and spinal fusion there is a higher risk of acute proximal collapse, due to the increased
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stiffness of the fused spinal segment that increases loads and motion within adjacent segments1
.
Several risk factors have been described for this “topping-off syndrome”: length of the fusion construct, reduced sagittal plane
lordosis, female gender, age over 60 years and presence of osteoporosis2
.
Vertebral augmentation with cement (vertebroplasty or kyphoplasty) is a per- cutaneous procedure performed to stabi- lise vertebral insufficiency fractures and
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