Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature
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(2020) 21:619
CASE REPORT
Open Access
Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review Liang Dong1*† , Chunke Dong2†, Yuting Zhu3 and Hongyu Wei4
Abstract Background: Among common findings in osteoporotic vertebral compression fractures (OVCFs), the intravertebral cleft (IVC) is usually considered a benign lesion. The current study was aimed to present a rare case of vertebral fracture caused by IVC-related spinal tuberculosis. Case presentation: A 73-year-old female complained of back pain and weakness in lower limbs for 2 weeks. 3 months ago, after a minor trauma, she got back pain without weakness in lower limbs. Initially, she was diagnosed with a L1 compression fracture and accepted conservative treatment. After an asymptomatic period, she complained progressive pain at the fracture position with weakness of both lower limbs and was referred to our hospital with suspicion of Kümmell’s disease. The patient underwent posterior debridement and internal fixation for decompression and stabilization of the spine. Pathological examinations revealed the patient with spinal tuberculosis. Conclusions: Although IVC is common in patients with OCVFs, there are some cases believed to be found in patients with spinal tuberculosis or infection. Further test, like CT-guided puncture biopsy, may be required before decisive treatment when an IVC is observed. Keywords: Intravertebral cleft, Vertebral fracture, Spinal tuberculosis, Case report
Introduction The intravertebral cleft (IVC), which was first described by Maldague in 1978, has long been considered the result of local bone ischemia associated with nonunion vertebral collapse [1]. Patients with IVC often present with a transverse, linear or semilunar radiolucent shadow, indicating the collection of air inside the vertebral body [1, 2]. However, several studies have also observed fluid accumulation within non-healing intervertebral clefts in patients with benign OVCFs, which depends on the position of the
* Correspondence: [email protected] † Liang Dong and Chunke Dong contributed equally to this study and should be considered co-first authors 1 Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, No 555, YouYi East road, Xi’an 710054, China Full list of author information is available at the end of the article
patient secondary to the extension momentum in the supine position [3, 4]. Although several studies have found that IVC can be found in pathologically fractured vertebrae caused by infections, multiple myeloma and malignant tumors [5–8], IVC is highly suggestive of a benign lesion due to rare reports. We retrospectively reviewed the imaging data containing X-rays, CT, and MRI of 149 consecutive patients with IVC. Among them, 46 patients underwent a spinal reconstructive surgery and intraoperative biopsy. To the best of our knowledge, few studies have reported detailed pathological results and treatment for vertebral fracture caused by IVC-related spinal tub
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