Evolution of vertebral posttraumatic necrosis to bone healing after self-stabilizing osteophytosis development-case report

Abstract

Post-traumatic vertebral necrosis and pseudarthrosis at the thoracolumbar transition level usually progresses to bone resorption, leading to vertebral collapse, sometimes with retropulsion of the posterior wall and neurological deficit. As such, the therapeutic goal is the interruption of this evolution, seeking to stabilize the vertebral body, preventing collapse progression and the risk of neurological deficits. We present a clinical case regarding the evolution of a vertebral pseudarthrosis that self-stabilized with the development of an exuberant anterior osteophyte mass, joining the anterolateral surfaces of the adjacent vertebrae bodies. Vertebrae stabilization would have made it possible to minimize the pathological hypermobility that perpetuated pseudarthrosis and would have ensured sufficient stabilization to obtain clinically and imagiologically proven vertebrae bone healing. However, despite the unusually favorable evolution of this clinical case, in order to avoid highly disabling symptoms for several months, as occurred with the patient for 4 to 6 months, we consider that early percutaneous surgical stabilization of symptomatic vertebral pseudarthrosis is indicated, allowing for almost immediate pain relief and functional improvement, which is beneficial in terms of health and quality of life. This is a clinical case of unusual evolution of vertebral pseudarthrosis, which, however, is useful to confirm the prolonged duration and intensity of symptoms in the face of a conservative treatment for this disease.