Thoracic Pyogenic Spondylitis Misdiagnosed As Osteoporotic Compression Fracture Status Post Vertebral Augmentation With Resultant Paraplegia: A Case Report

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 6; p. e63497
• Main Authors: Chen, Po-Wei, Liu, Ping-Chuan, Lee, Chin-Cheng, Lam, Chee-Tat
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 30.06.2024; Cureus
• Subjects: Abscesses; Back pain; Biopsy; Case reports; Epidural; Fever; Fractures; Infections; Infectious Disease; Inflammation; Lupus; Magnetic resonance imaging; Medical imaging; Neurosurgery; Orthopedics; Paralysis; Patients; Polymethyl methacrylate; Steroids; Surgery; Tomography; Wu Ho-Su; United States > US; complication; vertebroplasty; misdiagnosis; pyogenic spondylitis; vertebral augmentation
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.63497

This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified , indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.