Treatment of a Compression Fracture at a Previously Instrumented Lumbar Vertebral Body Using Balloon Kyphoplasty: A Technical Case Report

Compression fractures are common among osteoporotic patients and can be a significant source of pain and disability. Patients who suffer a compression fracture at an instrumented level of a lumbar fusion are most often treated conservatively. Herein, we demonstrate a safe and effective treatment for a vertebral compression fracture (VCF) at a previous level with instrumented fusion and pedicle screw fixation. An 89-year-old female with a history of multiple osteoporotic compression fractures treated with previous kyphoplasties and a prior instrumented fusion at L4-L5 presented with debilitating lower back pain for one week. After failing conservative management, computed tomography (CT) and magnetic resonance imaging (MRI) study of the lumbar spine revealed an acute VCF of the previously instrumented L5 vertebral body. Under biplanar fluoroscopy, a balloon kyphoplasty was performed at the L5 vertebrae utilizing the Inflatable Vertebral Augmentation System (IVAS) from Stryker® (Kalamazoo, MI, USA). We were able to demonstrate that the treatment of an acute VCF with balloon kyphoplasty is feasible in patients who have a history of previous instrumentation with pedicle screws remaining at the fracture level.