Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 677-684
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.677
Intervertebral bridging ossification after kyphoplasty in a Parkinson’s patient with Kummell’s disease: A case report
Jie Li, Yun Liu, Lei Peng, Jian Liu, Zhi-Dong Cao, Miao He
Jie Li, Lei Peng, Jian Liu, Zhi-Dong Cao, Miao He, Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
Yun Liu, Department of Radiology, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
Author contributions: Li J is the main writer of the article, that is, the first author; Li J, Liu Y, Peng L, Liu J, Cao ZD and He M designed the research study; Li J and Liu J performed the research; Li J, Liu Y, Peng L, Liu J, Cao ZD and He M analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Liu, MD, Doctor, Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), No. 1 Jiankang Road, Chongqing 400010, China. liujian19800714@sina.com
Received: July 8, 2021
Peer-review started: July 8, 2021
First decision: October 22, 2021
Revised: October 24, 2021
Accepted: December 8, 2021
Article in press: December 8, 2021
Published online: January 14, 2022
Abstract
BACKGROUND

The short-term therapeutic efficacy of kyphoplasty on Kummell’s disease is obvious. However, postoperative refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative refracture and adjacent vertebral fracture, providing new stability.

CASE SUMMARY

A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient’s VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient's back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.

CONCLUSION

Kyphoplasty is currently a conventional treatment for Kummell's disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.

Keywords: Kummell's disease, Parkinson's disease, Kyphoplasty, Refracture, Heterotopic ossification, Case report

Core Tip: Kyphoplasty is an effective surgery for the treatment of Kummell's disease. However, occasional refracture of the vertebral body can seriously affect the prognosis of patients, and it is very difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with high rates of heterotopic ossification. But no cases of Parkinson's disease causing intervertebral bridge formation have been reported. In our case, the PD patient suffered a refracture of the vertebra after kyphoplasty, and cured by the formation of a large number of intervertebral Bridges.