Posterior Midline Interspinal Fixation (PMIF) to Treat Persistent Severe Pain Due to Severe Compression Fracture of Thoracic Vertebral Body: A Case Report

Generally, severe persistent pain due to compression fractures of the lumbar and thoracic vertebral bodies in the elderly, that fail conservative measures are treated with vertebroplasty or kyphoplasty. However, in the case reported in this paper, the compression fracture was so severe, that accurate bone needle placement into the vertebral body was felt to be difficult. In addition, there was a high risk of extravasation of the cement into the surrounding structures or blow-up of the lateral wall of the vertebral body. Therefore, a simple operation of posterior midline interspinal fixation (PMIF) was performed. The patient was a 91-year-old lady with severe pain in the mid-thoracic spine due to a severe compression fracture of the seventh thoracic vertebral body that was totally flattened in its anterior part. The patient was neurologically intact. However, she had difficulty walking, because the pain was very severe in an upright position. She was treated with a back brace and oxycodone for six weeks without any benefit. Because she was a poor candidate for vertebroplasty or kyphoplasty, a PMIF system was implanted. Postoperatively, within two weeks, her pain score dropped from 9/10 to 0/10; and from two months onwards she was completely free of pain medications until her death from an unrelated cause, 18 months after the operation. This is the first reported case of PMIF for the treatment of pain due to vertebral body compression fracture in the elderly. PMIF is a simple minimally invasive procedure without compromising the facet or any bony structure. The risk of severe complications, therefore, is remote. The success in this single case, therefore, begs for further exploration of this method in the treatment of compression fractures in the elderly.