Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra

Jacobson, Robert E; Palea, Ovidiu; Granville, Michelle

doi:10.7759/cureus.1776

Cited by 19 publications

(39 citation statements)

References 31 publications

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“…Recompression may lead to changes in spinal balance, local kyphosis, and consequently chronic pain. Especially when there is a fracture in vertebral endplate, if the cement is not well connected with the endplate, it will provide insu cient support and lead to the continuous compression of the fracture vertebral body, which is the reason for the persistence of postoperative pain [22].He found that the long-term effect of H-type distribution of bone cement is better than O-type distribution, which is related to the closer contact between bone cement, endplates and cancellous bone in H-type distribution [23]. Our study and previous literatures show that if the bone cement is evenly distributed and closely contacted with the upper and lower endplates, it can better maintain the strength and height of the vertebral body, reduce recompression risk and eventually improve the patients' chronic back pain.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

Tan

Wen²,

Guo

et al. 2020

Preprint

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Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared. Results: 24 hours post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6-24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR. Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.

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Section: Discussionmentioning

confidence: 99%

“…There were 26 males and 111 females, with an average age of 69 ± 7.0 years old. The average follow-up time was 15.3 ± 6.3 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months.…”

mentioning

confidence: 99%

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

Tan

Wen²,

Guo

et al. 2020

Preprint

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“…The presence of previous or multiple sequential fractures is significant and changes both the immediate treatment, as well as the long-term treatment and general prognosis, including life expectancy [ 1 , 4 ]. It is important to make sure that the entire symptomatic area is included in the radiologic field and adjacent areas, such as the thoracic-lumbar junction, are adequately visualized to avoid missing junctional fractures [ 14 - 15 ]. Poor-quality plain X-ray films can occur because of technician error, patient obesity, and especially because of the poor bone detail frequently seen in osteoporotic vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…Initial films are assessed for level of fracture, percentage of collapse, and any degree of angulation or kyphosis. Scoliosis is not commonly caused by VCF but may be present secondary to underlying spinal degeneration and may complicate film interpretation and, later, any interventional procedure leading to poor pain relief or failure of vertebral augmentation [ 15 ]. A radionucleotide bone scan, showing one or more areas of positive vertebral uptake, is an important sign of fracture activity.…”

Section: Discussionmentioning

confidence: 99%

Radiologic Evaluation of Chronic Vertebral Compression Fractures and Role of Vertebral Augmentation

Hatgis

Palea²,

Ghomri

et al. 2018

Cureus

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The literature has classified chronic vertebral compression fractures (VCF) as those still "symptomatic" four or more months after onset. Pain is regarded as the predominant chronic symptom; however, radiologic changes are important in evaluating fracture progression. This review examines a series of patients with chronic fractures and both persistence of spinal pain combined with radiologic changes, such as worsening collapse, spinal angulation, the development of vertebral edema and clefts, as well as the development of new fractures at adjacent spinal levels. In patients with clear progressive radiologic changes in addition to pain, vertebral augmentation on an average of 9.3 months after injury was effective in reducing the pain and stabilizing these more chronic osteoporotic fractures. A comparison of the pre- and post-procedure visual analog scale score (VAS) indicated an average of 66% reduction in pain. There are several reasons for the development of chronic symptomatic fractures. Most commonly, interventional treatment is delayed in a patient already diagnosed with VCF after a long period of conservative treatment, yet pain persists, or the initial clinical and radiologic evaluation misses the fracture, leading to a delay in diagnosis and treatment. In this report, management in these patients and the role of late vertebral augmentation for chronic symptomatic fractures is clarified based on the findings of various radiologic changes seen on both initial and follow-up radiologic studies.

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“…Since these elderly patients frequently have lumbar stenosis (LS), often with degenerative spondylolisthesis (DS) or lumbar degenerative scoliosis (LDS), determining the cause of radiculopathy or directly relating it to the fracture can be difficult [ 6 ]. When a patient develops subsequent fractures after treatment with either vertebroplasty or kyphoplasty, it is important to differentiate between the worsening of a previously treated fracture and the development of a new fracture at an adjacent or another spinal level [ 7 ]. The reported frequency of the development of symptomatic new fractures at an adjacent level after previous vertebroplasty or kyphoplasty ranges from 10% to 29% [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures

Sabo¹,

Hatgis²,

Granville

et al. 2017

Cureus

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Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the incidence of recurrence in other vertebrae.

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Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra

Cited by 19 publications

References 31 publications

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

Radiologic Evaluation of Chronic Vertebral Compression Fractures and Role of Vertebral Augmentation

Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures

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