Vertebral Body Fracture During Manual Therapy in a Patient Following Spinal Surgery and Previous Instrumentation Removal

Spinal fusion with metallic implants is a widely used surgical approach to manage various spinal pathologies including instability and degenerative diseases. Although spinal instrumentations facilitate successful bone fusion by providing immediate rigid support and stability, their removal may be necessary because of pain, mechanical failure, or infection. However, implant removal, particularly in patients with low bone density, may lead to fractures of the fused vertebral bodies owing to stress-shielding effects. This case report describes a 70-year-old woman with a history of spinal fusion surgery at the L3-L4-L5 levels who underwent another spinal fusion surgery at the L5-S1 level and removal of previous implants owing to adjacent segment disease. During recovery, the patient developed sudden severe back pain due to vertebral body fractures at the L3 and L4 levels following manual therapy. Percutaneous vertebroplasty was performed to treat these fractures and allowed for recovery without any complication. This case highlights the importance of careful preoperative planning and postoperative management in preventing fractures associated with hardware removal.