Cognizance on the re-fracture of the operated vertebra with cemented augmentation in osteoporotic vertebral compression fractures

Abstract

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement. The vertebral height is restored and the decreased loading ability of the fractured vertebral body is restrengthened with pain relief. The effect of the method is widely demonstrated in those conditions. At the same time, the relative problems, such as the complications are being lucubrated and discussed. The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more. By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various. The mechanisms and correlative factors are still not clear-cut either. The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0% to 63%. The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification, failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on. Great controversy still exists on the correlation between those possible factors and the re-fractures. More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.