Bone cement displacement after percutaneous vertebroplasty for a three-column fracture: a case report

BACKGROUND: Since the first case report by Tsung-Ting Tsai, bone cement displacement (BCD) has emerged as a catastrophic complication. Factors contributing to this complication include high body mass index (BMI), intravertebral clefts, vertebral wall fractures, excessive Cobb angle correction, and bone cement leakage, among others. However, it remains unclear whether performing percutaneous vertebroplasty (PVP) surgery alone for preoperatively easily missed unstable spinal fractures is a potential risk factor for the occurrence of BCD. This case presents a rare case in which a three-column fracture was misdiagnosed as a simple compression fracture, leading to bone cement displacement after PVP surgery. We analyzed the causes of misdiagnosis and proposed feasible treatment strategies and preventive suggestions. CASE PRESENTATION: An early 70s male underwent PVP for a three-column fracture was misdiagnosed as a L1 simple compression vertebral fracture. About 45 days after the surgery, he developed lower back pain along with pain in both sides of the groin areas and the front area of his thighs. X-ray imaging revealed a forward movement (anterior displacement) of the bone cement from the L1 vertebral body. The patient underwent surgery involving posterior pedicle screw fixation and bone graft fusion, covering T11–L2 vertebra. Following this surgery, the patient reported significant improvement in his symptoms. CONCLUSION: PVP for three-column spinal fractures carries a risk of BCD. Accurate identification of three-column fractures before surgery is the key to preventing displacement of BCD. For BCD patients with poor overall condition, selecting pure pedicle screw internal fixation to reconstruct spinal stability may be a potentially feasible alternative to alleviate the patients’ clinical symptoms.