Spontaneous Compression Fracture on the Instrumented End Vertebra: A Case Report

ABSTRACT

STUDY DESIGN: A case report. OBJECTIVES: This case report presents an elderly male who sustained compression fractures twice on the instrumented end vertebra following a spinal fusion with pedicle screws. SUMMARY OF LITERATURE REVIEW Because of its low incidence, there is considerable debate regarding an optimal treatment of adjacent segment fracture after long lumbar fusion. Almost all of the reports about adjacent segment fracture are about adjacent vertebral fractures rather than the instrumented vertebral fractures. MATERIALS AND METHODS: A 69 year-old male who was admitted with low back pains of no apparent physical injury underwent pedicle subtraction osteotomy and posterolateral fusion for L3 vertebral fracture and post-traumatic kyphosis. Extension of the fusion segment was performed two months after the initial operation to correct his compression fracture of the instrumented end vertebra, followed by conservative treatments due to a second compression fracture of the instrumented end vertebra two months after the second surgery. RESULTS: Conservative treatment was performed with TLSO brace, after which the fracture was gradually stabilized. CONCLUSIONS: Further research via additional case studies is required to better understand its cause and to develop effective treatment options.