Spondylitis following vertebroplasty. Case report and review of the literature

We report the observation of a 76-year-old female who was treated with percutaneous vertebroplasty for an L3 osteoporotic compression fracture. Fifteen days after this procedure, a cauda equina syndrome occurred. The neuroimaging studies showed worsening of the compression fracture and the appearance of a posterior wall displacement. Blood test results showed a moderate inflammatory syndrome resembling lymphangitides complicating a venous arm perfusion. Therapeutic options consisted of a combined surgical approach associating an anterior approach with implantation of a corporeal prosthesis and a posterior osteosynthesis. At the postoperative period, the patient presented hyperthermia peaks and Staphylococcus aureus grew on three consecutive hemocultures. MRI evaluation demonstrated septic pseudarthrosis, the corporeal prosthesis was removed in a second combined approach, and it was replaced with an iliac crest graft, with posterior debridement. A three-month course of antibiotics was given. The follow-up was good with overall recovery of the deficit and disappearance of the fever. This case report emphasizes the importance of suspecting postprocedure spondylitis when in the follow-up neuroimaging of a vertebroplasty, an increasing compression fracture is noted even though the clinical picture of sepsis is not apparent.