New Vertebral Osteoporotic Compression Fractures after Percutaneous Vertebroplasty: Retrospective Analysis of Risk Factors

Lin, Wei-Che; Cheng, Tien‐Tsai; Lee, Yu-Chang; Wang, Tsu‐Nai; Cheng, Yu‐Fan; Lui, Chun‐Chung; Yu, Chun‐Yen

doi:10.1016/j.jvir.2007.09.008

Cited by 87 publications

(66 citation statements)

References 21 publications

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“…This may explain the relatively low rate of adjacent-segment fractures (12%) as compared with other studies. 3,6,[20][21][22] Spross et al observed a 10% rate of adjacent-vertebra fracture until 6 months postoperatively, whereas we found this same rate after an average of 33 months. 28 Indications for a reoperation other than a new fracture were rare: 4 patients developed a painful segmental instability and required an instrumented fusion between 6 and 37 months postoperatively.…”

Section: Discussioncontrasting

confidence: 64%

“…This is a higher percentage than the reported rate for a new fracture in the literature, which varies between 17% and 27%, based on different observation periods. 15,[20][21][22] In a large cohort from the SWISSspine registry, a 21% rate for new spine fractures during 1 postoperative year after BKP was observed. 12 In a subcohort with monosegmental osteoporotic fractures from the SWISSspine registry, Spross et al revealed a preoperative segmental kyphosis > 30°, or patients with comorbidities such as rheumatoid arthritis and a cardiovascular disease, to be at high risk of adjacent-segment fracture after BKP within 6 months after the index surgery.…”

Section: Discussionmentioning

confidence: 99%

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Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures

Hoppe

Budmiger

Bissig

et al. 2016

SPI

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OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9–86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24–108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures

Hoppe

Budmiger

Bissig

et al. 2016

SPI

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“…The incidence of subsequent vertebral fracture after vertebroplasty or kyphoplasty in other studies has varied between 7.9% to 24% [24][25][26][27][28]. Several factors, including a greater degree of height restoration of the cemented vertebrae, greater kyphotic angle correction, cement leakage into the disc, shorter distance from the treated vertebrae, presence of more than two pre-existing vertebral compression fractures and low body mass index (BMI) may increase the incidence of a new vertebral compression fracture after the procedures [24,[28][29][30]. However, Harrop et al suggested that the kyphoplasty protocol involving a concurrent medical osteoporotic regimen does not appear to increase the incidence of remote and adjacent fractures in patients with primary osteoporotic fractures [31].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures

Song

Eun

2009

Osteoporos Int

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“…In addition, patients with high parathyroid hormone concentrations, low body mass index, no use of back brace, no anti-osteoporosis therapy, history of metabolic disease, and use of drugs which influence bone metabolism tend to have a greater risk of recurrent fractures [16,17,47]. Studies on refractures of augmented vertebrae focused on the influence of vertebral height restoration, distribution patterns of cement in the augmented vertebra and intravertebral clefts [52], pre-operative osteonecrosis [18,53], fracture shape, loading case and elastic modulus of fracture region and cement [51].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Purpose Vertebral augmentation with PMMA is a widely applied treatment of vertebral osteoporotic compression fractures. Subsequent fractures are a common complication, possibly due to the relatively high stiffness of PMMA in comparison with bone. Silicone as an augmentation material has biomechanical properties closer to those of bone and might, therefore, be an alternative. The study aimed to investigate the biomechanical differences, especially stiffness, of vertebral bodies with two augmentation materials and two filling grades. Methods Forty intact human osteoporotic vertebrae (T10-L5) were studied. Wedge fractures were produced in a standardized manner. For treatment, PMMA and silicone at two filling grades (16 and 35 % vertebral body fill) were assigned to four groups. Each specimen received 5,000 load cycles with a high load range of 20-65 % of fracture force, and stiffness was measured. Additional low-load stiffness measurements (100-500 N) were performed for intact and augmented vertebrae and after cyclic loading. Results Low-load stiffness testing after cyclic loading normalized to intact vertebrae showed increased stiffness with 35 and 16 % PMMA (115 and 110 %) and reduced stiffness with 35 and 16 % silicone (87 and 82 %). After cyclic loading (high load range), the stiffness normalized to the untreated vertebrae was 361 and 304 % with 35 and 16 % PMMA, and 243 and 222 % with 35 and 16 % silicone augmentation. For both high and low load ranges, the augmentation material had a significant effect on the stiffness of the augmented vertebra, while the filling grade did not significantly affect stiffness. Conclusions This study for the first time directly compared the stiffness of silicone-augmented and PMMAaugmented vertebral bodies. Silicone may be a viable option in the treatment of osteoporotic fractures and it has the biomechanical potential to reduce the risk of secondary fractures.

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New Vertebral Osteoporotic Compression Fractures after Percutaneous Vertebroplasty: Retrospective Analysis of Risk Factors

Cited by 87 publications

References 21 publications

Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures

Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures

Clinical and radiological comparison of unipedicular versus bipedicular balloon kyphoplasty for the treatment of vertebral compression fractures

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

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