Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra
A 65-year-old female presented to our pain clinic complaining of low back pain. A month earlier she had experienced pain in the low back and right flank area, and was diagnosed with osteoporotic VCF in the first and fourth lumbar vertebral bodies (L1 and L4). Unipedicular VPs were performed with the injection of 2 ml and 2.5 ml of PMMA into each vertebra, respectively (). After the procedure, the visual analogue scale (VAS) reduced from 10 to 8, and her flank pain subsided. This state continued without additional pain relief.\nSeveral days before her visit to our clinic, the patient's back pain worsened and became aggravated when sitting, standing up, or changing her posture (VAS 10). She was also unable to stand or walk unassisted. On physical examination, only tenderness of the L1 spinous process was present and there were no neurological abnormalities. An interval progression of anterior wedging in the L1 vertebral body was detected on lumbar plain radiograph, and MR images showed findings consistent with the refracture of L1 (). Based on these results, we concluded that the previous VP in L1 had failed to relieve her pain and that refracture of L1 worsened the symptoms. We therefore proceeded to repeat VP in the L1 vertebra.\nAfter obtaining informed consent from the patient and her family, repeat VP was performed in the L1 vertebral body using a bipedicular approach with the patient in the prone position. When the bone fillers reached the fractured cavity of the L1 vertebral body, we then slowly injected 3.5 ml of PMMA bone cement on each side under real-time C-arm fluoroscopic guidance to prevent cement leakage and to ensure even dispersion of cement in the fractured lesion (). No cement leakage or dislocation of the previous injectate was detected. During the VP procedure, blood pressure, EKG, and mixed venous oxygen saturation were monitored, and oxygen was supplied via nasal cannula. In addition, a total of 100 mcg fentanyl was administered intravenously for analgesia.\nThe day after the procedure, the patient's VAS dropped from 10 to 4, and she reported only discomfort in the procedure area. She was also able to walk unassisted, and was therefore discharged on that day. When she visited our clinic a month after the repeat VP, her pain and immobility had resolved completely.