Disclosures: Richa Lamba, MD: Nothing to disclose

Case Description: Patient initially presented with 2 months of low back pain after a lifting injury. MRI of the lumbar spine demonstrated an L4 burst fracture with mild retropulsion into the canal without evidence of significant spinal nerve compression. Subsequently, she underwent percutaneous vertebroplasty of L4 vertebral body performed via left transpedicular approach. Back pain initially improved but patient presented to the emergency room on second post-operative day (POD) with worsening left buttock pain, weakness of left leg, and difficulty voiding. Repeat MRI of the lumbar spine showed worsening central stenosis due to retropulsion of fracture fragments and vertebroplasty material causing moderate L4-L5 spinal canal stenosis. Patient then underwent lumbar decompression of L3-L5 and fusion of L2-S1.

Setting: University Hospital

Patient: 60-year-old female with worsening left leg pain and weakness following vertebroplasty.

Assessment/Results: Manual muscle testing prior to vertebroplasty showed bilateral lower extremity (LE) weakness, quantified as 4/5 strength. At representation on second POD, patient had 5/5 strength in the right lower extremity (RLE), 3/5 strength in the left hip flexor (LHF), and the remainder of the left lower extremity (LLE) had 4-/5 strength. Two days after lumbar decompression/fusion, patient’s LLE weakness had improved with the LHF having 4/5 strength and remainder of LLE with 5/5 strength. At a 4-week follow up appointment patient’s bilateral LE strength had returned to 5/5 with complete resolution of pain. Patient continued to do well at a 2-month follow up appointment.

Discussion: Percutaneous vertebroplasty is a mainstay for treating vertebral fractures and the transpedicular route is thought to minimize complications. Complications, although rare, can be severe as evidenced by this case.

Conclusion: This case presents a rare mechanism for development of acute symptomatic foraminal stenosis as a complication of vertebroplasty.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/foraminal-stenosis-as-a-sequela-of-vertebroplasty-a-case-report/