Thoracolumbar Posterior Pedicle Screw Fixation and Laminectomy for an Osteoporotic Vertebral Fracture Resulting From Acute Lymphoblastic Leukemia in an Adult Patient: A Case Report

Vertebral fractures (VFs) occasionally appear as the first manifestation of acute lymphocytic leukemia (ALL) in children. However, in adults, it is uncommon for VFs to lead to a diagnosis of ALL, and surgical intervention is even rarer. We encountered a case of a 42-year-old man with ALL who presented with acute severe back pain, lower limb numbness, dysuria, and hamstring weakness. A CT scan revealed a burst fracture of the L2 vertebra with spinal canal stenosis. Laboratory results indicated pancytopenia, and an emergency bone marrow biopsy suggested leukemia. Emergency surgery, including lumbar laminectomy (L1-L3) and pedicle screw fixation (T11-L4), was performed, after which the patient's back pain and dysuria resolved, and hamstring strength improved. Bone mineral density testing revealed osteoporosis, later diagnosed as secondary to ALL. The patient was subsequently diagnosed with ALL with Philadelphia chromosome abnormality and underwent chemotherapy and bone marrow transplantation. He remains in remission four years after the operation. In cases of symptomatic nerve compression due to VFs secondary to adult-onset ALL, early posterior decompression and fixation can help maintain good performance status and lead to favorable outcomes. This case represents the first reported instance where surgical intervention was performed specifically to maintain performance status for early chemotherapy in such patients. Additionally, in young adults presenting with osteoporotic VFs, hematologic malignancies such as ALL should be considered in the differential diagnosis.