Abstract
BackgroundRecently percutaneous vertebroplasty (PVP) was frequently performed for treatment of osteoporotic vertebral fractures (VFs). It is widely accepted that new compression fractures tend to occur adjacent to the vertebral bodies, typically within a month after PVP. To determine the risk factors among several potential predictors for de novo VFs following PVP in patients with osteoporosis.MethodsWe retrospectively screened the clinical results of 88 patients who had been treated by PVP. Fifteen cases were excluded due to non-union. Of the remaining 73 patients, 19 (26.0 %) later returned with pain due to a new vertebral compression fracture. One patient with a non-adjacent fracture and 2 patients with adjacent factures occurring 3 months later were excluded from the study. The 9 male patients were excluded to avoid gender bias. Ultimately, we divided the 61 remaining postmenopausal female patients (mean age: 78.9 years) into the collapse group (14 patients) who had experienced adjacent vertebral collapse after PVP and the non-collapse group (47 patients) who had not. Logistic regression analysis was performed to identify the risk factors for new VFs after PVP.ResultsAll 14 cases of adjacent VF occurred within the first month after surgery. The collapse group had significantly advanced age, higher urinary N-terminal cross-linking telopeptide of type I collagen, and lower lumbar and hip bone mineral density (BMD) scores as compared with the non-collapse group. The odds ratios for age, lumbar, total hip, femoral neck, and trochanteric BMD were 4.5, 8.2, 4.5, 7.2, and 9.6, respectively. Positive likelihood ratios suggested that age more than 85 years, lumbar BMD less than 0.700 [−2.6SD], total hip BMD less than 0.700 [−1.8SD], neck BMD less than 0.600 [−2.1], and trochanter BMD less than 0.600 conferred an elevated risk of adjacent VF.ConclusionsOur study revealed that advanced age and decreased lumbar and hip BMD scores most strongly indicated a risk of adjacent VF following PVP.
Highlights
Percutaneous vertebroplasty (PVP) was frequently performed for treatment of osteoporotic vertebral fractures (VFs)
There have been several reports on the risk of fracture following operations for VF [8, 10]. Since these studies were over differing follow-up periods and did not include such factors as bone turnover markers, we focused exclusively on adjacent VFs manifesting within a month after surgery and analyzed patient characteristics, bone marker values, and bone mineral density (BMD) scores to identify risk factors associated with clinical outcome
The indication for percutaneous vertebroplasty (PVP) was incidental VF, regardless of radiographic vertebral collapse, causing significant back pain that could not be relieved by conservative measures, such as nonsteroidal anti-inflammatory drug (NSAID) treatment
Summary
Percutaneous vertebroplasty (PVP) was frequently performed for treatment of osteoporotic vertebral fractures (VFs). It is widely accepted that new compression fractures tend to occur adjacent to the vertebral bodies, typically within a month after PVP. The incidence of osteoporotic fractures is increasing yearly in Japan. As these injuries greatly diminish quality of life (QOL) and activities of daily living in the elderly, methods of preventing osteoporosis and osteoporotic fractures are urgently required [1, 2]. Osteoporotic VFs frequently cause persistent back pain, which significantly impairs mobility and QOL [3]. Indications for percutaneous vertebroplasty (PVP) spread widely to include osteoporotic vertebral compression fracture. In their review of 1000 consecutively treated vertebral compression fractures, Layton et al found that this technique had a high success rate and low complication rate for cases of painful spinal compression fractures [5]
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