Vertebra plana – An unusual adult case series

The term vertebra plana describes compression induced > 70% reduction in vertebral body height with a local kyphotic angle >15 degrees. Although in children this Xray radiological finding has historically been regarded as pathognomonic for a vertebral body eosinophilic granuloma / Langerhans cell histiocytosis, the accuracy of this assumption in pediatric patients has been challenged in several papers, and even more so in adult patients where this association is considered weak. In adult patients who present with the Xray finding of vertebral plana the attending neurosurgeon must bear in mind a myriad of underlying infective, primary / secondary bone malignancies, including metabolic bone diseases. For this reason, a thorough initial systemic investigation towards diagnosing the underlying cause must be undertaken, failing which CT guided biopsy of the involved vertebral body should be performed. Regarding patients who present with vertebra plana and progressive neurological deterioration secondary to neural compression, although the percutaneous vertebroplasty and posterior stabilization techniques have demonstrated equal efficacy, most spine surgeons advocate a combination of the two to achieve restoration of vertebral body height, correction of kyphotic angulation, and restoration of spinal stability. We describe a short series of two adult patients who demonstrated vertebra plana on Xray imaging, both of which had progressive neurology secondary to significant neural compression. In our first patient where the underlying etiology was found to be spinal tuberculosis, we were able to achieve a decompression of the conus medullaris, correction of kyphotic angulation, and restored spinal stability through a combined open anterior and posterior approach, and the patient had a favorable outcome. In our second patient, where the underlying cause was found to be metastatic disease, we opted for posterior decompression and stabilization alone and we failed to correct the kyphotic angulation and whether spinal stability was achieved is debatable.