Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

Abstract

The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.

Percutaneous Vertebroplasty Is Not a Risk Factor for New Osteoporotic Compression Fractures: Results from VERTOS II

“…[9][10][11][12][13]20 On the other hand, some studies have reported an increased risk of new VCFs after PV. 5,6,8,20,21 However, most of these studies were small nonrandomized follow-up only studies, lacking a control group without intervention.…”

“…[5][6][7][8] Others dispute this assumption and consider the incidence of new VCFs dependent on the presence and severity of osteoporosis. [9][10][11][12][13] To elucidate this controversy, we assessed the incidence of new VCFs during follow-up in 202 patients with acute VCFs randomized to PV and conservative therapy from VERTOS II.…”

Is 3T-MR Spectroscopy a Predictable Selection Tool in Prophylactic Vertebroplasty?

“…However, few patients return to the hospital due to recurrent back pain after PVP. The main discussion is lacking regarding the cause of new compression fracture after PVP; new collapse occur more often in the adjacent vertebral bodies to those treated by PVP [5][6][7] and in the ''sandwich'' bodies levels localized between two somatic collapses [8].…”

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

“…Reported complications, possibly due to the addition of a material that is stiffer than the surrounding bone, include fractures of the augmented and adjacent vertebrae. New osteoporotic vertebral compression fractures, in the months after VP, are reported in 7-63 % of VP patients, up to 82 % of these occur at the adjacent levels, with adjacent fractures occurring sooner than nonadjacent fractures; rates of recurrent fracture of the augmented vertebra itself range up to 63 % in the literature [1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. It is still under debate whether new vertebral fractures appear more often in patients who received cement augmentation than in conservatively treated patients; some studies support this hypothesis [1,6,7,[27][28][29], while others question it [2,3,26,30].…”