An unconventional indication for open kyphoplasty

Abstract Background context Kyphoplasty is a means of treatment for painful osteoporotic vertebral body compression fractures. Its efficacy has not yet been totally proven. Even though the conventional percutaneous kyphoplasty is a relatively safe procedure, it is not routinely recommended for use in vertebral body fractures that involve posterior cortical compromise/retropulsion or in fractures associated with neurological deficit. Purpose To see whether the open kyphoplasty procedure can be used in patients with painful vertebral body compression fractures who also have bony retropulsion into the spinal canal. Study design/setting This technical report is based on the experience of one patient. Methods A 79-year-old woman with a history of osteoporosis presented with a painful vertebral body compression fracture at T12. Magnetic resonance imaging of her lumbar spine demonstrated an acute compression fracture at T12 with significant decrease in vertebral body height and retropulsion of bone resulting in one-third reduction in canal width. She was not considered a candidate for percutaneous kyphoplasty. Three months after the injury, an open kyphoplasty was performed after a decompression laminectomy at T12. Results The fractured vertebral body was successfully reduced, and there was no leakage of polymethylmethacrylate into the spinal canal through the fractured posterior cortex using the open kyphoplasty procedure. One month after the operation, the patient was free from mid-back pain and was again able to walk. Conclusion Open kyphoplasty procedure allows direct visualization to the spinal canal. It can be performed safely and effectively in selected vertebral body compression fractures with retropulsed bone associated with neurological deficit.