Pain
Charles Abrams, BS
University of Connecticut School of Medicine - Farmington, CT
Farmington, Connecticut, United States
Justin E. Pratte, DO
PGY3 Resident
University of Connecticut PM&R Residency Program
Newington, Connecticut, United States
David E. Gutierrez, MD
Assistant Professor
UCONN School of Medicine and Frank H. Netter MD School of Medicine
Hartford, Connecticut, United States
Charles Abrams, BS
University of Connecticut School of Medicine - Farmington, CT
Farmington, Connecticut, United States
T11 compression fracture after L4,L5,S1 basivertebral nerve ablation (BVNA)
Case Description:
An 85-year-old male with past medical history of flat back syndrome & osteoporosis. The patient had been working with pain management for the previous 5 years, successfully treating radicular pain with physical therapy, multiple epidural steroid injections and recent cluneal nerve ablation. However, on follow-up, patient was experiencing persistent axial vertebrogenic back pain. Recent MRI demonstrated Modic Type 2 endplate changes at L2-L3, L4-S1, and it was decided to proceed with BVNA at L4-S1. At three weeks post-procedure, the patient reported no complications. At six weeks, they began reporting increasing back pain, without specific trauma or inciting incident. X-ray revealed expected post-procedural changes, and no other significant interval changes. MRI revealed loss of vertebral body height with bony edema indicative of acute-subacute compression fracture at T11 without retropulsion. The patient underwent successful T11 kyphoplasty. At post-procedural follow-up patient was recovering from well with no further complaints of back pain.
Discussions:
While it is unclear if this compression fracture was a complication of the procedure, or spontaneous, high clinical suspicion should be maintained for changing character of pain within 2-3 months of BVNA procedure in patients with risk factors. Even if X-ray is negative, and MRI may be warranted to confidently rule out compression fracture at vertebral segments local or distant to site of procedure. Compression fractures have typically been reported at the level of procedure, or adjacent segments in lumbar region within 75 days post-procedure. One other case report of sacral insufficiency fracture has been reported, but this is the first report of thoracic compression fracture associated with BVNA.
Conclusions:
Compression fracture is an uncommon but possible complication after BVNA. Complications may occur at or distant from treated levels and require careful evaluation. MRI may be necessary when initial radiographs are unremarkable.
