Percutaneous Vertebroplasty for Symptomatic Osteoporotic Vertebral Compression Fracture Adjacent to Lumbar Instrumented Circumferential Fusion

Abstract

The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors' institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky's criteria were used to compare clinical outcomes pre- and postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients' visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease.

Effect of Zoledronic Acid on the Vertebral Body Bone Mineral Density After Instrumented Intervertebral Fusion in Postmenopausal Women With Osteoporosis

“…The impact of lumbar instrumented intervertebral fusion on the development of adjacent VCFs has been discussed in some studies, with evidence of an increased risk after spinal arthrodesis. 4,5,[19][20][21][22] Yang et al reported new VCFs in 150 of 1348 patients (11.1%) after posterior lumbar interbody fusion, with 108 of these (72%) being at adjacent segments. 19 Although no study has examined the relationship between new VCFs at the adjacent segment and bone loss after spinal instrumentation surgery directly, it is known that women, the elderly, and patients with osteoporosis have a specific higher incidence of new VCFs after spinal fusion, especially within the first 12 months postoperatively.…”

Corpectomy with Adjacent-Level Kyphoplasty to Treat Metastatic Lung Cancer in Three Contiguous Cervical Vertebrae Causing Focal Neurologic Compromise

“…Cement augmentation has been widely used in the thoracolumbar spine to treat osteoporotic compression fractures adjacent to instrumented fusion procedures. 4 More recently, it has also been reported in the cervical spine. 5 The authors report on how balloon kyphoplasty in particular can be used to simultaneously treat lytic lesions in the posterior vertebral body and also augment the stability of an anterior cage and plate construct following C7 corpectomy.…”