Idiopathic avascular necrosis of a vertebral body. Case report and literature review

STUDY DESIGN: Case report and literature review. OBJECTIVES: To review the English literature pertaining to idiopathic avascular necrosis of a vertebral body. As an illustrative example, the case of a 60-year-old woman with idiopathic avascular necrosis of L4 is presented. SUMMARY OF BACKGROUND DATA: Avascular necrosis of a vertebral body is an uncommon entity. Avascular necrosis has been described in the context of other underlying lesions, such as with malignancy, infection, radiation therapy, and systemic steroid treatment. The intravertebral vacuum cleft phenomenon seen on plain films has been strongly associated with vertebral body avascular necrosis. METHODS: Literature and chart review was carried out. Vertebral body avascular necrosis was initially identified with imaging studies and confirmed with biopsy. A comprehensive preoperative evaluation did not identify a specific cause of avascular necrosis. The patient underwent vertebral body resection with fibula allograft struts. CONCLUSIONS: Although vertebral body collapse in an osteoporotic individual is relatively common, a case is reported of vertebral body collapse and subsequent necrosis without evidence of underlying disease at 48-month follow-up. The current findings support the diagnosis of idiopathic avascular necrosis of L4.