- •A rare case of L5 vertebral fracture occurred after pedicle screw removal from PLIF.
- •Posterolateral fusion surgery and vertebroplasty were used to correct the fracture.
- •Possible reasons for the fracture include decreased vertebral mass.
- •PLIF at the adjacent segment may have increased mechanical stress.
- •Stress-shielding-related osteopenia and age-related osteoporosis may be involved.
It is uncommon to remove pedicle screws after posterolateral lumbar interbody fusion (PLIF), and there are a few case reports of vertebral fracture involving holes remaining after screw removal. We report a case of the vertebral fracture after removing pedicle screws instrumented for PLIF. A 66-year-old woman with osteopenia, who underwent PLIF at L4–S1 10 years earlier, underwent PLIF at L3–L4 to correct adjacent-segment degeneration. We removed L5 and S1 pedicle screws, and inserted L3 pedicle screws. After surgery, she presented with severe progressive low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an L5 body fracture involving the pedicle screw holes. Revision surgery, including posterolateral fusion from L3 to S2 alar iliac and L5 vertebroplasty, was performed. One year after the revision surgery, the patient remained pain-free and returned to normal activity. Possible reasons for instrumented vertebral body fracture after pedicle screw removal are decrease of vertebral mass, increased mechanical stress caused by PLIF at the adjacent segment, stress-shielding-related osteopenia, and spinal imbalance. Vertebral body fractures associated with spinal implant removal are rare, but possible, especially in elderly patients with osteopenia and osteoporosis.
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Published online: September 19, 2018
Accepted: April 9, 2018
Received: February 13, 2018
© 2018 Elsevier Ltd. All rights reserved.