Recurrent Pain After Percutaneous Vertebroplasty

Lin, Chih-Ta; Shen, Wu‐Chung; Lo, Yu-Chien; Liu, Yi-Jui; Yu, Tzai‐Chiu; Chen, Ing-Ho; Chung, H D

doi:10.2214/ajr.09.3287

Cited by 29 publications

(30 citation statements)

References 49 publications

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“…PVP appeared to relieve pain effectively and restore vertebral body height in most studies [3, 21]. Although PVP relieves the pain of compression fractures, recurrent back pain after PVP is common [21]. Among our group B patients, the VAS score was 2.95 ± 1.56 at month 12 and 3.14 ± 1.58 at month 18 ( p = 0.329).…”

Section: Discussionmentioning

confidence: 83%

“…Kallmes et al demonstrated in a randomized controlled trial that improvements in pain and pain-related disability associated with osteoporotic VCFs in patients treated with vertebroplasty were similar to the improvements in a simulated procedure without the use of cement (control group) [20]. PVP appeared to relieve pain effectively and restore vertebral body height in most studies [3, 21]. Although PVP relieves the pain of compression fractures, recurrent back pain after PVP is common [21].…”

Section: Discussionmentioning

confidence: 99%

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Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Tseng¹,

Su²,

Lui³

et al. 2011

Osteoporos Int

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SummaryMost post-vertebroplasty new-onset adjacent vertebral compression fractures (VCFs) occur within 2–3 months, and antiresorptive agents do not significantly reduce the risk of their occurrence. In opposite mechanism, teriparatide directly stimulates bone formation and improves bone strength and quality faster. The therapeutic effect of teriparatide is better than that of vertebroplasty combined with an antiresorptive treatment and is a potentially useful therapy for new-onset adjacent VCFs after vertebroplasty.IntroductionFollowing vertebroplasty, patients are at increased risk of new-onset adjacent-level VCFs. The therapeutic effect of antiresorptive agents is too slow, and they are associated with the risk of new VCFs. Teriparatide markedly increases bone formation and strength and reduces the incidence of new-onset VCFs. This prospective cohort study compared the therapeutic effects of teriparatide with those of combined vertebroplasty and an anti-resorber for treating new-onset adjacent VCFs after vertebroplasty.MethodsFifty patients with adjacent VCFs were randomly assigned to two groups: teriparatide only (group A) and additional vertebroplasty combined with an antiresorptive agent (group B). Relevant clinical data of the two groups were prospectively compared.ResultsThe 22 patients in group A were at higher risk of new VCFs than those in group B (22 patients); they were older and had more pre-existing fractures (p < 0.05). Patients treated with teriparatide had a significantly lower incidence of new-onset VCFs (odds ratio = 0.21; 95% confidence interval, 0.02–2.10). Teriparatide-mediated VCF reduction was 78.57%, which was markedly better than that of group B. The teriparatide group had a significant decrease in the visual analog scale and an increase in the Japanese Orthopedic Association low back pain score after 6 months of treatment (p < 0.05). The increase in lumbar spine BMD was marked in the teriparatide group (21.70% vs. 6.87%) after an 18-month treatment.ConclusionsTreatment of post-vertebroplasty adjacent VCFs with teriparatide (no new vertebroplasty) was more effective than that of repeated vertebroplasties combined with an anti-resorber.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Tseng¹,

Su²,

Lui³

et al. 2011

Osteoporos Int

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“…However, pain can recur in 1.8-15.6% of patients after VP, which is attributable to rib fracture, infection, non-healing bone-cement interface, or new symptomatic compression fractures [7]. In addition, inadequate impactions of bone cement can make the unfilled intravertebral spaces collapse or the injectates loosen after procedures [6].…”

Section: Discussionmentioning

confidence: 99%

Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

et al. 2013

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Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

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“…Many mechanisms exist for pain after vertebral augmentation procedures. Same/adjacent level pain may result from vertebral body deformity at the fracture site, cement leakage, fracture progression, a new VCF, facet arthropathy, nerve root entrapment, rib fractures, infection, and non-healing bone-cement interface [5]. In the presence of high-grade pain during the immediate/subacute post-procedure period, specific causes related to the fracture and/or procedure must be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…The facet joints, both at same/adjacent levels and non-adjacent levels, as well as an L4 spinal nerve, were responsible for the other types of pain. Non-adjacent level pain may result from pre-existing lumbar spine pathology, including lumbar spinal stenosis, spondylosis, spondylolisthesis, and facet arthropathy [5]. Multiple axial structures may contribute to patients’ pain including intervertebral discs, muscles, ligaments, nerves, and fascia.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Interventional Management of Pain After Vertebral Augmentation Procedures

Hatgis¹,

Granville

Jacobson

2017

Cureus

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IntroductionA small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches. The pattern of facet injections relative to the original fracture level was studied. Additionally, the elapsed time between the vertebral augmentation and the subsequent interventional blocks was also evaluated.MethodsA total of 56 patients sustained VCFs. 12 of these patients underwent interventional procedures after vertebral augmentation procedures. The level(s) of same/adjacent level and non-adjacent level pain were determined via physical examination and/or imaging studies. These levels were subsequently treated with interventional procedures primarily focused on the facet joints. The time period of the injections varied from two weeks status post-vertebral augmentation to as late as 304 weeks (5.8 years) status post-vertebral augmentation.ResultsWe performed 25 vertebral augmentation procedures on these 12 patients. 15 lumbar, eight lower thoracic, and two mid-thoracic VCFs were augmented. 9/14 cases of blocks included those performed at non-adjacent levels, whereas 5/14 cases of blocks were performed only at the same and/or adjacent levels as the VCF. For the events in which thoracic VCFs were augmented, 6/7 (or 86%) had developed non-adjacent level pain in areas of the lumbar spine. The time from vertebral augmentation procedure to subsequent pain procedure ranged from two weeks to five plus years. The average time elapsed was 83 weeks. Only one case required blocks performed within the first six weeks after vertebral augmentation. In this case, the blocks included those at non-adjacent levels. A total of 4/12 cases (33%) had a block within 12 weeks of the original vertebral augmentation procedure.Lumbar spine imaging showed that at least 9/12 patients had pre-existing significant lumbar pathology at the time of fracture treatment. This may have contributed to the later development of pain.ConclusionPain after a successful vertebral augmentation is typically non-acute (i.e., beyond six weeks). Mechanisms other than the primary VCF are usually responsible for non-adjacent level pain, which are present a majority of the time on reviewing the patients' diagnostic studies. These mechanisms usually take many weeks to develop and subsequently elicit pain that requires additional interventional pain procedures. In our study, the pain is usually related to the pre-existing degenerative spondylosis and stenosis rather than the fracture site. This study shows that the facet joints in closely related lumbar degenerative changes are ...

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Recurrent Pain After Percutaneous Vertebroplasty

Abstract: Percutaneous vertebroplasty is widely used to treat patients with symptomatic osteoporotic compression fractures. Although the procedure relieves the pain of the compression fracture, recurrent back pain after percutaneous vertebroplasty is common.

Cited by 29 publications

References 49 publications

Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

Evaluation and Interventional Management of Pain After Vertebral Augmentation Procedures

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