Li-Sheng Hou1, Dong Zhang2, Feng Ge3, Hai-Feng Li3, Tian-Jun Gao3. 1. Department of Orthopedic Surgery, The Sixth Medical Center of PLA General Hospital, Fucheng Road, Haidian District, Beijing, 100048, China. nghohls@163.com. 2. Department of Orthopedic Surgery, The Sixth Medical Center of PLA General Hospital, Fucheng Road, Haidian District, Beijing, 100048, China. zhangdong3611776@163.com. 3. Department of Orthopedic Surgery, The Sixth Medical Center of PLA General Hospital, Fucheng Road, Haidian District, Beijing, 100048, China.
Abstract
BACKGROUND: Previous research and published literature indicate that some patients with spinal diseases who underwent percutaneous transforaminal endoscopic decompression (PTED) still suffer some discomfort in the early recovery stage in the form of pain, stiffness, and swelling. These are usually considered minor residual symptoms or normal postoperative phenomenon (NPF) in the clinic, occur frequently, and are acknowledged by surgeons worldwide. To the best of our knowledge, we report the first case of a patient who had an osteoporotic vertebral fracture (OVF) misdiagnosed as NPF after she underwent PTED as a result of lumbar disc herniation (LDH). CASE PRESENTATION: A 71-year-old female with Parkinson's disease who presented with lower back pain radiating to the legs was diagnosed as LDH in L4-5, after which a PTED of L4-5 was performed, with temporary alleviation of symptoms. However, severe lower back pain recurred. Unfortunately, the recurred pain initially misdiagnosed as NPF, in fact, was finally confirmed to be OVF by CT-scan. OVF in the early stage of post-PTED seldom occurs and is rarely reported in the literature. With a percutaneous vertebroplasty, the pain was significantly relieved, and she resumed walking. After 36-weeks of follow-up, the pain improved satisfactorily. CONCLUSION: Doctors should not immediately diagnose a relapse of back pain following PTED as NPF, and hands-on careful physical and imaging examinations are necessary to manage recurring pain rightly and timely.
BACKGROUND: Previous research and published literature indicate that some patients with spinal diseases who underwent percutaneous transforaminal endoscopic decompression (PTED) still suffer some discomfort in the early recovery stage in the form of pain, stiffness, and swelling. These are usually considered minor residual symptoms or normal postoperative phenomenon (NPF) in the clinic, occur frequently, and are acknowledged by surgeons worldwide. To the best of our knowledge, we report the first case of a patient who had an osteoporotic vertebral fracture (OVF) misdiagnosed as NPF after she underwent PTED as a result of lumbar disc herniation (LDH). CASE PRESENTATION: A 71-year-old female with Parkinson's disease who presented with lower back pain radiating to the legs was diagnosed as LDH in L4-5, after which a PTED of L4-5 was performed, with temporary alleviation of symptoms. However, severe lower back pain recurred. Unfortunately, the recurred pain initially misdiagnosed as NPF, in fact, was finally confirmed to be OVF by CT-scan. OVF in the early stage of post-PTED seldom occurs and is rarely reported in the literature. With a percutaneous vertebroplasty, the pain was significantly relieved, and she resumed walking. After 36-weeks of follow-up, the pain improved satisfactorily. CONCLUSION: Doctors should not immediately diagnose a relapse of back pain following PTED as NPF, and hands-on careful physical and imaging examinations are necessary to manage recurring pain rightly and timely.
Authors: Jeroen Hoogland; Judith A Boel; Rob M A de Bie; Ben A Schmand; Ronald B Geskus; John C Dalrymple-Alford; Connie Marras; Charles H Adler; Daniel Weintraub; Carmen Junque; Kenn F Pedersen; Brit Mollenhauer; Jennifer G Goldman; Alexander I Tröster; David J Burn; Irene Litvan; Gert J Geurtsen Journal: Mov Disord Date: 2019-01-17 Impact factor: 10.338