Fractures In Adjacent Vertebrae Research Articles

Lumbar posterior group muscle degeneration: Influencing factors of adjacent vertebral body re-fracture after percutaneous vertebroplasty.

The purpose of the study was to explore the influencing factors of adjacent vertebral re-fracture after percutaneous vertebroplasty (PVP) for osteoporosis vertebral compression fractures (OVCFs). We retrospectively analyzed the clinical data of 55 patients with adjacent vertebral re-fracture after PVP operation for OVCFs in our hospital from January 2016 to June 2019, they were followed up for 1 year and included in the fracture group. According to the same inclusion and exclusion criteria, we collected the clinical data of 55 patients with OVCFs without adjacent vertebral re-fracture after PVP in the same period and included them in the non-fracture group. We performed univariate and multivariate logistic regression analysis on the influencing factors of adjacent vertebral re-fracture in patients with OVCFs after PVP. There were significant differences in body mass index (BMI), bone mineral density (BMD) T-value, amount of bone cement injected, bone cement leakage, history of glucocorticoid use, cross-sectional area (CSA), cross-sectional area asymmetry (CSAA), fat infiltration rate (FIR), and fat infiltration rate asymmetry (FIRA) of lumbar posterior group muscles [multifidus (MF) and erector spinae (ES)] between the two groups (p < 0.05). There was no significant difference in sex, age, or time from the first fracture to operation, the CAS, CSAA, FIR, and FIRA of psoas major (PS) between the two groups (p > 0.05). Multivariate logistic regression showed that a higher dose of bone cement, greater CSAA and FIR of multifidus, and higher CSAA of erector spinae were independent risk factors for recurrent fractures of adjacent vertebrae after PVP. There are many risk factors for recurrent vertebral fracture after PVP in patients with OVCFs, and degeneration of paraspinal muscles (especially posterior lumbar muscles) may be one of the risks.

Effect of different bone cement distributions in percutaneous kyphoplasty on clinical outcomes for osteoporotic vertebral compression fractures: A retrospective study.

Osteoporotic fractures and their complications are becoming increasingly harmful to the elderly. This study aimed to evaluate the clinical results of connected or unconnected bilateral cement after bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). The clinical data of 217 patients with single-segment OVCF were retrospectively collected. Patients were allocated into 2 groups according to the bilateral bone cement in the vertebrae was connected or unconnected after surgery. The surgery-related indexes of the 2 groups were compared, including operation time; bone cement injection volume; contact situation between bone cement and the upper and lower endplates of the vertebral body; visual analogue scale (VAS) scores before surgery, 1 week and 1 year after surgery; Oswestry disability index (ODI) before surgery, 1 week and 1 year after surgery; local kyphosis angle (LKA) before surgery, 1 week and 1 year after surgery; postoperative vertebral body height at 1 week and 1 year after surgery; vertebral body height restoration rate (HRR) at 1 week and 1 year after surgery. The follow-up results of all patients were recorded. The postoperative VAS, ODI, vertebral body height, LKA and other indexes of the 2 groups were significantly improved compared with those before the operation (P < .05), and there was no significant difference between the 2 groups (P > .05). At the same time, there were no significant difference in vertebral body HRR and bone cement leakage rate between the 2 groups (P > .05). X-ray examination showed that 21 of 217 patients (21/217, 9.8%) had a refracture of the injured vertebral body, including 16 cases (16/121, 13.2%) in the unconnected group and 5 cases (5/96, 5.2%) in the connected group (P < .05). Adjacent vertebrae fractures occurred in 25 cases (25/217, 11.5%), while 19 cases (19/121, 15.7%) were in the unconnected group and 6 cases (6/96, 6.3%) were in the connected group (P < .05). PKP has a good therapeutic effect on OVCF no matter whether the bilateral bone cement is connected or not. However, if the bilateral cement inside the vertebra was connected, the risk of recollapse of the injured vertebrae and the new fracture of adjacent vertebrae could be reduced.

The Acute VertEbRal AugmentaTion (AVERT) study: protocol for a randomised controlled, feasibility trial of spinal medial branch nerve block in hospitalised older patients with vertebral fragility fractures

IntroductionVertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture found in older people, resulting in increasing morbidity and excess mortality. These fractures can cause significant pain, requiring...

Biomechanical Assessment of Vertebroplasty Combined with Cement-Augmented Screw Fixation for Lumbar Burst Fractures: A Finite Element Analysis

A hybrid fixation method, using a combination of vertebroplasty and cement-augmented screws, has been demonstrated as a useful technique for securing osteoporotic burst fractures. The purpose of this study was to assess changes in the range of motion (ROM) and stress in the spine after treating a lumbar burst fracture with this hybrid method. Five finite element models were developed: (a) intact lumbar spine (INT), (b) INT with vertebroplasty at L3 (AwC), (c) two-segment fixation of AwC (AwC-TSF), (d) AwC-TSF model with cement-augmented screws (AwC-TSF-S), and (e) INT with an L3 burst fracture treated with two-segment fixation (TSF). After loading, the models were evaluated in terms of the ROM of each motion segment, stiffness of fusion segments, and stresses on the endplates and screws. The results showed that the TSF model has a larger ROM at the instrumented segments than both the AwC-TSF and AwC-TSF-S models. The stiffness at L2–L4 under extension and lateral bending in AwC-TSF, AwC-TSF-S and TSF was approximately nine times greater than the INT model. In conclusion, the hybrid fixation method (AwC-TSF-S) results in a stiffer construct and lower ROM at instrumented segments, which may also reduce the risk of fracture of adjacent vertebrae.

Progression of the risk factors researches of adjacent vertebral fractures after vertebral augmentation for osteoporotic vertebral compression fracture

Vertebral augmentation has been widely used for treating the osteoporotic vertebral compression fractures. However, the occurrence of new fractures in adjacent vertebrae is also common. In order to understand the mechanism of adjacent vertebral fractures to prevent its happening, many scholars have carried out a lot of experiments and clinical studies by different research methods for years. As a result, many theories about the mechanism of adjacent vertebral fracture have been formed. Including the patients' general conditions (age, gender, bone mineral density, body mass index, et al), material characteristics of bone cement, distribution of bone cement (volume of bone cement and under-endplate distribution, acentric or bilateral distribution, compact and solid cement filling pattern, bone cement leakage), factors of spinal sagittal imbalance, factors of anti-osteoporosis treatment and the behavioral therapy, the location of initial injured vertebral level, the degeneration of adjacent disc, all of above were considered as potential risk factors. However, various researches lead to diverse conclusions because of different methods were used and different research factors were included, some conclusions were even opposite. Therefore, it is still controversial that whether some of the risk factors were effective. In this research, the current researches and the reliability and limitations of various research methods were reviewed to put forward a relatively objective interpretation, in order to provide evidences for understanding the risks of adjacent vertebral fracture after vertebral augmentation, and to provide reference for treatment.

Method for preventing fractures of adjacent vertebrae during transpedicular fixation in osteoporosis

Objective. To substantiate experimentally a method for preventing adjacent vertebra fractures during cement transpedicular fixation of vertebral fractures in osteoporotic patients. Material and Methods . An experimental study included the assessment of overall strength of 10 cadaver blocks of Th 10 -L 4 vertebral segments with simulated Magerl’s type A fracture at the L 1 level and transpedicular fixation at the Th 12 -L 2 levels with four-screw system and cement augmentation. In five control blocks, only cement augmented transpedicular fixation was performed after the L 1 fracture simulation. In five blocks of the study group it was supplemented by vertebroplasty at Th 11 and L 3 levels cranial and caudal to the level of fixation. Load testing of the blocks was carried out by destruction under the influence of a vertically directed force. Results . Vertical loading of anatomical specimens in the control group (average of 0.84 kN) caused Th 11 vertebral body fractures. In the study group, the vertebrae augmented by vertebroplasty were resistant to loading. Fractures occurred in the Th10 vertebral bodies (over the vertebra with vertebroplasty) under the average load of 1.91 kN. Conclusion . Vertebroplasty of the vertebra overlying the level of transpedicular fixation is an effective way to prevent its fracture.

Percutaneous kyphoplasty via the uni-extrapedicular approach for treatment of lower osteoporotic vertebral compression fractures

Objective To investigate the clinical efficacy and safety of the uni-extrapedicular percutaneous kyphoplasty (PKP) versus the unipedicular PKP in the treatment of lower osteoporotic vertebral compression fractures (OVCF). Methods From January 2011 to January 2013, 47 patients with lower OVCF were treated at our department. The uni-extrapedicular PKP was conducted for 25 of them (28 compressed vertebrae, group A) while the unipedicular PKP for the other 22 (24 compressed vertebrae, group B). The 2 groups were compatible, showing no significant differences in preoperative clinical data (P>0.05). The 2 groups were compared in terms of operation time, fluoroscopy frequency, volume of injected cement, cement leakage, and cobb angle, anterior vertebral height, visual analogue scale (VAS) score, Oswestry disability index (ODI), SF-36 score, and cement filling preoperatively, 3 days and one year postoperatively. Results All the patients had an uneventful operation and were followed up for at least one year. Compared with group B, group A reported significantly shorter operation time, lower fluoroscopy frequency, less cement leakage, better cement filling, and a lower rate of fracture of adjacent vertebra (all P 0.05). Conclusion Both of the 2 methods are safe and effective treatments of OVCF, but the uni-extrapedicular PKP may be more advantageous because it leads to shorter operation time and lower fluoroscopy frequency. Key words: Thoracic vertebrae; Fractures, bone; Osteoporosis; Vertebroplasty; Cement

Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for preventing secondary fracture after vertebroplasty.

BackgroundPercutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) could give rise to excellent outcomes and significant improvements in pain, analgesic requirements, function, cost, and incidence of serious complications for thoracolumbar osteoporotic vertebral compression fractures (VCFs). But some studies showed the recurrent fracture of a previously operated vertebra or adjacent vertebral fracture after PVP or PKP. The purpose of this study was to compare minimally invasive pedicle screw fixation (MIPS) and PVP with PVP to evaluate its feasibility and safety for treating acute thoracolumbar osteoporotic VCF and preventing the secondary VCF after PVP.MethodsSixty-eight patients with a mean age of 74.5 years (ranging 65 ~ 87 years), who sustained thoracic or lumbar fresh osteoporotic VCFs without neurologic deficits underwent the procedure of PVP (group 1, n = 37) or MIPS combined with PVP (group 2, n = 31). Visual analog scale pain scores (VAS) were recorded and Cobb angles, central and anterior vertebral body height were measured on the lateral radiographs before surgery and immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after surgery.ResultsThe patients were followed for an average of 27 months (ranging 24–32 months). The VAS significantly decreased after surgery in both groups (P < 0.005). The central and anterior vertebral body height significantly increased (P < 0.005), and the Cobb angle significantly decreased (P < 0.05) immediately after surgery in both groups. No significant changes in both the Cobb angle correction and the vertebral body height gains obtained were observed at the end of the follow-up period in group 2. But the Cobb angle significantly increased (P < 0.005), and the central and anterior vertebral body height significantly decreased (P < 0.005) 2 years after surgery compared with those immediately after surgery in group 1, and there were five patients with new fracture of operated vertebrae and nine cases with fracture of adjacent vertebrae.ConclusionsMIPS combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF, which can prevent secondary VCF after PVP.

Risk Factors for New Vertebral Fractures after Percutaneous Vertebroplasty in Patients with Osteoporosis: A Prospective Study

To determine the risk factors for new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PV) in patients with osteoporosis. This prospective study included 132 consecutive patients with osteoporosis treated with PV in a single institution over 46 months from March 2005 to December 2008. Multivariable logistic regression and univariate analysis were employed to identify risk factors for new VCFs after PV, including patient demographic data, parameters of the initial and new fractured vertebrae, procedure-related information, and follow-up data. During the follow-up period (22.4 months ± 12.1), 80 new vertebral fractures occurred in 36 (27.3%) patients. Multivariate analysis showed that number of VCFs per time frame, computed tomography (CT) value of nonfractured vertebrae (T11-L2), activity level after discharge, duration of follow-up, and cement distribution in the inferior part of the vertebral body or close to the endplate were statistically correlated with new fractures (odds ratios, 2.63, 0.96, 3.59, 1.00, 0.30, and 0.05; P = .006, P = .001, P = .007, P = .004, P = .021 and P = .029). Univariate analysis showed preexisting old VCFs were correlated with new VCFs (P = .045). Subsequent compression fractures in adjacent vertebrae (45 of 80) occurred more frequently and sooner than nonadjacent vertebral fractures (both P < .05). The incidence of new VCFs after PV is relatively high and affected by several risk factors that are related to both the PV procedure and the natural course of osteoporosis.

Elastoplasty: First Experience in 12 Patients

Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) is used increasingly for pain relief in symptomatic neoplastic or osteoporotic compression fractures. However, restoration of the stiffness of the treated vertebrae might propagate secondary fracture of adjacent vertebrae. Elastoplasty might prevent these secondary fractures. We assessed retrospectively our experience with elastoplasty in 12 patients, focusing on silicone migration. During the period from July 2011 to January 2012, all patients with an indication for vertebroplasty were treated with elastoplasty. The exclusion criterion was the presence of posterior wall defects. Chest computed tomography (CT) scans were performed to evaluate the presence of perivertebral leakage and pulmonary embolism. The prevalence of leakage was compared with the results obtained for vertebroplasty with PMMA reported in the literature. Other complications during the postprocedural period were recorded. Twenty-one vertebral bodies in 12 patients were treated with elastoplasty. Silicone pulmonary emboli were detected on the postprocedural chest CT in 60 % (6/10) of the patients. Leakage to the perivertebral venous plexus was seen in 67 % (14/21) of the treated vertebrae. One major complication occurred: severe, medication-resistant dyspnea developed in one patient with multiple peripheral silicone emboli. This preliminary evidence suggests that VK100 silicone cement should not be used in elastoplasty because of the increased risk of silicone pulmonary embolism, when compared with the use of PMMA, which occurs worldwide. The major technical disadvantage is that the time taken for the VK100 silicone material to achieve its final strength is too long for practical application.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

Study DesignRetrospective study.PurposeTo evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty.Overview of LiteratureRecent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty.MethodsOne hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted.ResultsAverage bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05).ConclusionsThe factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.

Isolated unilateral facet dislocation of the lumbosacral junction

Traumatic unilateral facet dislocation of the lumbosacral junction without fracture or with non-displaced fractures of adjacent vertebrae is extremely rare. We describe a case of a young male who sustained a unilateral facet dislocation of the lumbosacral junction in a motor vehicle accident. The unusual features of this case include an unremarkable physical and neurological examination on presentation and absence of other substantial vertebral or extra-vertebral injuries.

Abstract No. 262: Bone healing in vertebroplasty

Pain improvement with vertebral body augmentation using PMMA is seen in greater than 90% of patients. Reduction in pain is due to reduction or elimination of micro-motion. PMMA polymerizes through an exothermic process, potentially causing thermal necrosis and eliciting a response of fibrous tissue layer around the polymer. Its application results in a permanent divide which prohibits fusion of fractured bone interfaces. Presented is the first USA series of vertebroplasty with a bi-phasic ceramic bone substitute, Cerament™ (Bone Support AB), with mechanical properties similar to cancellous bone. Cerament is designed to eliminate micro-motion of fragments and resorb in balance with bone remodeling. Cerament™ is a bi-phasic material comprising a powder of synthetic calcium sulfate (60% by weight) and a balance of sintered hydroxyapatite. Calcium sulfate is targeted by osteoclasts which trigger resorption. A carbonated apatite layer on HA particles attracts osteoblasts which progresses the second phase, bone remodeling, in balance with the resorption. When the Cerament™ powder is mixed with iohexol, an injectable paste is produced. This is demonstrated in the attached micrograph by Voor which illustrates the creeping substitution of new bone within Cerament™ filled critical defects in a rabbit model. Ease of injectability and flow provides a consistent and reproducible percutaneous application. The process is non-exothermic. Its construction delivers a compressive strength similar to cancellous bone when implanted and this restores initial strength. The stiffness is similar to cancellous bone to help prevent additional fractures in adjacent vertebrae. 20 patients have been treated in this first USA vertebroplasty series. 90% of patients have complete pain relief. Pain improved using a VAS score (in the 0 to 10 range) improved from 8.4 pre-op to 1.9 at one week on average. To date 2 patients have maintained an average VAS score of 1.8 at one year. No adjacent level fractures have been experienced to date. No post-operative complications have been reported in the series to date. Further details of the long term clinical results shall be discussed.

Vertebroplasty: What Is Important and What Is Not

It is important to try to clarify the methodology of vertebroplasty such as amount of cement needed, how many needles to use and the significance of cement extravasation. This prospective study evaluated the potential of vertebroplasty to increase the likelihood of an adjacent vertebral compression fracture (VCF) 1 year or less after vertebroplasty, the correlation between the cement volumes injected and pain relief, and the consequences of cement extravasation. Pain relief and the incidence of a subsequent fracture of adjacent vertebrae 1 year or less after vertebroplasty were evaluated in 357 patients (660 vertebrae) of mean age 77.5 years with osteoporotic VCFs. The correlation between cement volume and pain relief was assessed with a Pearson correlation coefficient; factors potentially predictive of subsequent adjacent VCFs were explored by multiple logistic regression analysis. Refracture of any vertebrae (adjacent or nonadjacent to the primary fracture) occurred in 18% of the patients 1 year or less after vertebroplasty. Refracture of adjacent vertebrae occurred 1 year or less after vertebroplasty in 12% of the patients. Neither cement volume nor extravasation of cement into the intravertebral disk was a significant predictor of adjacent VCFs. No correlation was found between cement volume and pain relief (r = -0.029). Extravasation of cement into the veins, soft tissue, or disk was observed in 33% of all of the treated VCFs and resulted in no complications. The incidence of an adjacent VCF 1 year or less after vertebroplasty was comparable with that expected for untreated osteoporotic VCFs. Neither the volume of cement injected nor extravasation of cement into the intravertebral disk affected the likelihood of subsequent adjacent VCFs. Cement volume did not correlate with pain relief.

Subsequent Fracture after Percutaneous Vertebroplasty Can Be Predicted on Preoperative Multidetector Row CT

Subsequent fracture is often seen after percutaneous vertebroplasty. The purpose of this prospective study was to evaluate preoperative multidetector row CT (MDCT) for the prediction of subsequent fractures after vertebroplasty. This study included 26 consecutive patients (18 women and 8 men) with osteoporotic compression fractures (58 vertebrae). A 64-section MDCT with multiplanar reformation was obtained 1 day before the procedure. Subsequent MR imaging was used to evaluate new fractures at least 3 months after treatment on a routine basis or if there was recurrent pain. We used logistic regression analysis with MDCT findings and clinical data for statistical evaluation according to the location of new fractures. Subsequent fractures were noted at 14 adjacent vertebrae (12.1%) in 13 patients and at 14 remote vertebrae in 6 patients (23.1%). Subsequent fractures in adjacent vertebrae tended to occur in small vertebrae before treatment (P < .05). Steroid medication and low CT value in nonfractured vertebrae were associated with subsequent fractures in remote vertebrae (P < .05). Further collapse of the treated vertebral bodies was noted in 10 patients (11 vertebrae [19.0%]) without specific findings (P > .05). The small size of the treated vertebrae may relate to subsequent fractures in adjacent vertebrae. Steroid use and low CT value of nonfractured vertebrae on preoperative MDCT can be associated with subsequent fractures in remote vertebrae.

Management of vertebral re-fractures after vertebroplasty in osteoporotic patients.

This study illustrates the usefulness of vertebral biopsy in osteoporotic patients previously treated with vertebroplasty (VP) who present at follow-up with a new fracture in a vertebral soma adjacent or distant from the collapsed vertebral body. Five hundred and fifty patients with osteoporotic vertebral collapse underwent a minimally invasive treatment with vertebroplasty (VP) for a total of 980 vertebral bodies. The approach was unipedicular in 520 patients and bipedicular in 30. Only cases with unclear findings at MR or CT (23 patients) were scheduled for a vertebral biopsy before VP treatment. The biopsy results were positive for haematological disease in only eight patients. A vertebral biopsy was carried out during re-treatment with VP in all patients who presented a vertebral refracture in the three month follow-up at a site adjacent to or distant from the previously treated vertebra (21 patients). We have found new fractures of adjacent vertebrae in 15 patients and new fractures of distant vertebrae in 16 patients at three month follow-up examination. Five of the 31 cases (16%) of spinal refracture, where during vertebroplasty treatment a bone biopsy and a sternal medullary aspiration had been carried out, an anatomopathological response to multiple myeloma was responsible for the refracture. It is useful to perform a spinal bone biopsy during re-treatment of the vertebroplasty procedure to rule out multiple myeloma or other disease as the cause of the new collapse in patients with osteoporotic disease presenting a new vertebral fracture in an adjacent or distant site from the previously collapsed vertebral body.

Clinical Outcomes with Hemivertebral Filling during Percutaneous Vertebroplasty

Vertebroplasty has been commonly used for the treatment of vertebral compression fractures. Practitioners usually attempt to maximize filling of the vertebral body with polymethylmethacrylate (PMMA), either by using a bipediculate approach with separate infusions in both hemivertebrae or by using a unipediculate approach with central needle placement that allows bilateral hemivertebral filling. This study serves to investigate the clinical efficacy of a unipediculate approach in which the cement injected does not cross the midline, with resultant "hemivertebroplasty." A retrospective review of 917 vertebroplasty procedures was performed. A radiologic review of each vertebroplasty in the data base was performed to extract the vertebroplasties in which there was filling of only 1 side of the hemivertebra, which we term "hemivertebroplasty." Pre- and postoperative evaluations (1-week to 2-year postprocedure) included a Visual Analog Scale (VAS) for pain, the Roland-Morris Disability Questionnaire (RDQ) scores, and information regarding new fractures and retreatment of augmented fractures. No significant difference was found between the hemivertebroplasty cases and the bilaterally filled vertebroplasty group in reducing VAS or RDQ scores. Moreover, survival analysis showed no significant difference in the risk of incident fracture between groups (hazard ratio = 0.81; 95% confidence interval, 0.33-2.65). On the basis of our results, unilateral "hemivertebroplasty" is as effective in reducing pain with activity and at rest and decreasing the RDQ scores as bilateral vertebral filling. Additionally, vertebrae undergoing unilateral filling were at no greater risk of refracture or fracture of adjacent vertebrae than bilaterally filled vertebrae.

Suivi prospectif du risque fracturaire après vertébroplastie utilisant un faible volume de ciment chez des patients ostéoporotiques

To prospectively compare the incidence of new fractures (as demonstrated on MR) within the first 3 months after an initial fracture in a population treated with low cement volume vertebroplasty and a population treated conservatively. From 49 patients admitted for osteoporotic vertebral compression fracture, 22 underwent CT guided vertebroplasty with injection of 1-3 ml of PMMA, and 27 were treated conservatively. All patients underwent MR at presentation and at 3 months to detect new compression fractures. Twelve patients (54%) treated with vertebroplasty showed new fractures at 3 months compared to 10 (37%) in the control group. This was not statistically different (p=0.049). In the vertebroplasty group, the new fractures involved vertebrae adjacent to the treated vertebra in 77% of cases (p=0.009) compared to only 15% in the control group. During the 3-month period, 3 patients, including 2 treated with vertebroplasty, required hospital admission due to fracture related acute lumbar back pain. The small amount of injected cement does not prevent fractures of adjacent vertebrae but does reduce the extravasation of PMMA in adjacent tissues.

The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved

PurposeTo identify the incidence of new vertebral compression fractures in women after kyphoplasty and to analyze influential factors in these patients.Materials and MethodsOne hundred and eleven consecutive female patients with osteoporotic vertebral compression fractures (VCFs) underwent kyphoplasty at 137 levels. These patients were followed for 15.2 months postoperatively. For the survey of new vertebral compression fractures, medical records and x-rays were reviewed, and telephone interviews were conducted with all patients.ResultsDuring that time 20 (18%) patients developed new VCFs. The rate of occurrence of new VCFs in one year was 15.5% using a Kaplan-Meier curve. Body mass index (BMI), symptom duration and kyphoplasty level were the statistically significant factors between the patient groups both with and without new VCFs after kyphoplasty. In the comparison between the adjacent and remote new VCF groups, the adjacent new VCF group showed a larger amount of polymethyl methacrylate (PMMA) use during kyphoplasty (p < 0.05). Before kyphoplasty, 9.9% of the patients had been prescribed medication for osteoporosis, and 93.7% of the patients started or continued medication after kyphoplasty. The development of new VCFs was affected by the number of vertebrae involved in the kyphoplasty. However, the lower incidence rate (15.5%) of new compression fractures might be due to a greater percentage (93.7% in our study) of patients taking anti-osteoporotic medication before and/or after kyphoplasty.ConclusionWhen kyphoplasty is planned for the management of patients with osteoporotic VCFs, the application of a small amount of PMMA can be considered in order to lower the risk of new fractures in adjacent vertebrae. The postoperative use of anti- osteoporotic medication is recommended for the prevention of new VCFs.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

Results: Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a preexisting fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05). Conclusions: The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.