2026 Volume 17 Issue 4 Pages 749-753
Introduction: Osteoporotic vertebral fractures of the mid-to-lower lumbar spine can present with neurological symptoms in the legs and may be challenging to treat. In this case report, PLIF using the modified CBT method following BKP resulted in a favorable outcome.
Case report: An 86-year-old male developed lower back pain and right lower limb pain after undergoing manual massage therapy. At another hospital, he was diagnosed with an L4 vertebral fracture and L4/5 lateral recess stenosis, for which BKP for L4 and L4/5 laminectomy were performed. While the leg symptoms initially improved postoperatively, right leg pain recurred on postoperative day 4. Since his symptoms did not improve, he was referred to our department two months after surgery. Exacerbation of right L4 foraminal stenosis due to the caudal endplate of L4 was observed. A right L4 nerve block was performed, leading to the disappearance of leg pain. L4/5 PLIF and bone fragment removal using the modified CBT method were performed and the leg pain disappeared.
Conclusion: In osteoporotic vertebral fractures of the middle and lower lumbar spine with neurologic symptoms in the legs, the lumbar intervertebral foramen containing the fracture fragments near the caudal endplate of the vertebral body should be evaluated to determine the treatment strategy.
If PLIF is selected to widen the intervertebral foramen following revision surgery after BKP, the modified CBT method is a useful technique that allows for firm fixation without interference between the screw trajectory and the cement.
