The incidence of compression fractures is increasing in aging populations. Differentiating pathological fracture types is complex and requires careful consideration during diagnosis. This case report describes the clinical course of a 54-year-old female patient presenting with progressive paraplegia after a back injury sustained while lifting a heavy object. Initial imaging revealed a burst fracture at T12 and severe spinal cord compression due to an epidural mass extending from T12 to L2. Clinical assessment raised suspicions of a hematologic malignancy or pathological fractures. Laminectomy and spinal fusion, along with mass removal, resulted in partial improvement in motor function and patient-reported pain levels. However, further evaluation and biopsy revealed chronic inflammation with fibrosis consistent with an unresolved hematoma. This case underscores the importance of a comprehensive differential diagnosis and multidisciplinary collaboration, integrating radiologic, surgical, and pathologic correlation, in the management of complex spinal pathologies.

Purpose
Thoracolumbar vertebral compression fractures (VCFs) are a leading cause of kyphosis and related biomechanical complications, often resulting in chronic back pain and reduced function. Balloon kyphoplasty has been widely used as a minimally invasive intervention to provide pain relief and restore vertebral height. The SpineJack system is a relatively novel technique that introduces mechanical distraction, offering potentially enhanced vertebral restoration. This study aims to compare these two effective treatments for thoracolumbar fractures.
Materials and Methods
This study analyzed 30 patients with thoracolumbar VCFs surgically treated, using the Spine-Jack system (n=10) or balloon kyphoplasty (n=20). Back pain was evaluated as VAS pain score and functional disability was assessed with Oswestry Disability Index (ODI) preoperatively and immediately postoperatively. Radiological outcomes were measured on plain lateral X-rays, including vertebral height restoration, segmental kyphosis angle, and sagittal vertical axis (SVA). Complications, such as cement leakage and adjacent vertebrae fractures, were recorded. Continuous variables – with t-tests and categorical variables- with chi-square tests, were analyzed. P-value less than 0.05 was considered statistically significant.
Results
Both the Spine-Jack system and balloon kyphoplasty were effective in reducing back pain and improving patients’ function, with significant improvements in VAS and ODI scores. However, the Spine-Jack system demonstrated superior vertebral height restoration (85% vs. 72%, p=0.03) and segmental kyphosis angle correction (12° vs. 9°, p=0.032) when compared to balloon kyphoplasty. Complication rates were all low and comparable between the two groups.
Conclusions
Although the Spine-Jack system and balloon kyphoplasty are all effective for thoracolumbar VCFs, the Spine-Jack system offered superior radiological outcomes in selected cases. Further studies may explore their complementary roles in managing thoracolumbar VCFs.