Case Study: Kyphoplasty on 68-Year-Old Patient
The Problem
68 y/o female presents for evaluation of acute onset lower back pain for which she presented to the emergency room. Initially, x-ray of the lumbar spine revealed loss of height of vertebral bodies at T12, L1 and L2. She has a remote history of previous compression fractures and history of chronic lymphocytic leukemia which was in remission at time of presentation.
She presented with severe lower back pain worse with flexion and rotation of the trunk and lumbar spine. She denied neurological symptoms including numbness, tingling, weakness of the upper or lower extremities or loss of bowel or bladder continence. Severity of her pain was 10/10.
The Diagnosis
Urgent MRI and CT of the lumbar spine were performed.
MRI of the lumbar spine revealed anterior wedging of L2 and L3 with associated edema along the anterior endplate at L2 suggesting subacute compression fracture.
Fracture of L2 demonstrated on STIR sagittal image and T2 axial image
CT of the lumbar spine revealed generalized osteopenia. Anterior wedging of L2 noted. Consistent with compression fracture.
The Treatment
This patient with known history of CLL was scheduled for urgent kyphoplasty of L2 with biopsy given her history of CLL. Kyphoplasty of L2 was performed without complication. The patient was instructed to return to home exercise program after the procedure and follow up with her oncologist. Biopsy results were conclusive and compatible with chronic lymphocytic leukemia. She was subsequently followed closely by oncology for continued treatment with chemotherapy and pain management for control of her pain.
Fluoroscopic view of the right unipedicular approach to L2 kyphoplasty with curved needle.
Final fluoroscopic image after injection of poly-methyl methacrylate for stabilization of L2 fracture.
Post-operative x-ray revealing interval L2 kyphoplasty.
The Outcome
68 y/o F who presented with acute onset lower back pain in the setting of remote history of chronic lymphocytic leukemia. She was found to have an L2 compression fracture. Kyphoplasty and biopsy of the vertebral body was performed. This allowed for rapid tissue diagnosis and treatment of her pathologic fracture and resulted in expedient referral to oncology for treatment of recurrence of chronic lymphocytic leukemia.
Meet the Surgeon
Adeepa Singh, MD, FAAPMR
Dr. Adeepa Singh completed her medical education at the State University of New York, Upstate Medical University, followed by Physical Medicine and Rehabilitation Residency at Robert Wood Johnson-JFK Medical Center. She subsequently completed subspeciality fellowship training in Interventional Pain at Montefiore Medical Center.
Dr. Singh is double board-certified in Physical Medicine and Rehabilitation and Pain Medicine. She specializes in minimally invasive treatment options for chronic pain, including compression fractures, neuromodulation, and regenerative medicine.