Figure 4

This 68-year old man with corticoid-induced secondary osteoporosis and multiple co-morbidity fell at home and presented with osteoporotic fractures at T12 and L1 (a, b). The MRI confirmed fresh fractures and revealed a spinal stenosis at T12/L1 (c). Since non-surgical therapy was not successful, neurological deficits were not prevalent, kyphoplasty at T12 and L1 was performed as a minimal intervention (d). Postoperatively the patient was mobilised and left the hospital 4 days after kyphoplasty. Two weeks later the patient was admitted to our emergency care unit with incomplete paraplegia sub T8. Laboratory diagostics revealed highly elevated leukocytes and C-reactive protein. Plain radiographs showed a thin radiolucency around the cement core on T12 (e). The MRI confirmed the suspected spondylitis and found additionally an epidural abscess (f, g). Therefore posterior decompression with instrumentation from T10 to L3 was performed and anterior corporectomy of T12 with complete cement removal and implantation of an expandable titanium-cage and bone graft was performed (h). An incomplete paraplegia sub L2 remained.