Posterior instrumentation after a failed balloon kyphoplasty in the thoracolumbar junction: a case report

INTRODUCTION Balloon kyphoplasty provides symptomatic relief of vertebral compression fractures in elderly patients. Peri-operative complications are rare; however, they can potentially be devastating. To the best of our knowledge, complications during balloon kyphoplasty have not been described previously in published case reports. CASE PRESENTATION A 66-year-old man who was a farmer of Caucasian origin presented with a 6-month history of back pain after a fall. We discovered a significant T12 wedge compression fracture, so we performed a T12 balloon kyphoplasty. Approximately 2 weeks after being discharged from our hospital, the patient presented with increasing back pain. He presented for a second time with excruciating pain on the left side of his thoracolumbar region, so he was admitted to our ward. X-rays did not show any further fractures or compromise, but magnetic resonance imaging showed extensive edema in the T11 and L1 vertebral bodies as well as fluid tracking from the T11-T12 disc into the vertebral body. Nine days after being discharged, the patient presented to the outpatient clinic with severe back pain. Magnetic resonance imaging at that visit showed edema at the levels above and below the T11/T12 disc. He was put into a brace and given 300mg of morphine, which did not provide any pain resolution. Posterior instrumentation from T9 to L2 (pedicle fixation of T9-T10 as well as L1-L2, rods in between and a crosslink above T11-T12) was performed as the final treatment, and the patient was discharged uneventfully. CONCLUSION Patients presenting with residual pain over a previous balloon kyphoplasty level should raise high suspicion for a fracture or complication involving the levels above and/or below the balloon kyphoplasty. The best way to treat fractures that develop after a failed balloon kyphoplasty is to instrument and fuse posteriorly. Our present case report shows that a high level of suspicion for possible new fractures should be maintained for all similar cases.