Fractures following percutaneous vertebral augmentation: The procedure or the underlying disease?

Abstract

Introduction: We report cases of three patients who had vertebral compression fractures (VCFs) that occurred temporally close to and at levels adjacent to prior percutaneous vertebral augmentation (PVA) of vertebral fractures. Our objective is to evaluate the association between PVA and new/adjacent-level vertebral fractures. Case Series: Case 1 presented to our Osteoporosis (OP) Clinic with a previous diagnosis of OP, briefly on alendronate. Following this, she had a compression fracture (CF) at L3 followed by balloon kyphoplasty (BK). She was then on teriparatide for two years. Following this, over a span of several months, she had CFs (T8-L2) requiring BK, with seven of those fractures within six months. Case 2 presented for evaluation in the setting of CFs. She had never received antiresorptive therapy. She underwent BK at T12 and L1, and was noted to have a new T11 fracture 3–4 weeks later. Case 3 presented with a prior history of CF at L3 requiring vertebroplasty. Later, over the course of one year, she had a CF of T12 treated with BK, followed by new vertebral fractures at T11 and L1 also treated with BK, and finally CF at T10, which was also treated with BK. Conclusion: These cases illustrate that new fractures my occur sooner and at adjacent levels following PVA, demonstrating a possible association between the two. Given the mixed data regarding this, we would like to emphasize the need for clinicians to complete a thorough OP work-up and discuss the risks and benefits of these procedures with patients