Early subsequent fracture after percutaneous vertebroplasty proven by magnetic resonance imaging

Subsequent fracture after percutaneous vertebroplasty (PVP) has been reported. We experienced a case with immediate subsequent fractures proven by MR images. A 65-year-old female who had suffered from rheumatoid arthritis and had been treated with steroids for over 20 years had multiple compression fractures with severe kyphosis in the upper thoracic spine. The bone mineral density was extremely low (T-score = -6.1). Because of the presence of intraosseous clefts at T7 and T8, the patient received initial PVP for these fractures. Although the patient reported partial pain relief the day after the procedure, she complained of new back pain on the second day after the procedure. MR images obtained four days after the initial treatment revealed new compression fractures at T5 and T9. The patient received a second PVP without complications. The patient gained pain relief without medication and without the recurrence of fractures on MR imaging taken nine months after the second PVP. Steroid-induced severe osteoporosis, kyphosis and intraosseous clefts may be causal for these fractures. Repeat treatment can provide pain relief.