Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients

Abstract

Percutaneous vertebroplasty (PVP) is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures (OVCFs). However, some patient populations experience recurrent vertebral fracture after initial successful procedure. There are a lot of literatures about the effectiveness of this procedure but few concerning the development of recurrent, new compression fracture. This is a retrospective review of all PVPs performed in author's institution from September 1999 to December 2001 to investigate the factors related to the development of new symptomatic OVCFs after PVPs. A retrospective review of 244 cases of PVP for symptomatic OVCFs at 382 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed and compared between the two patient groups (control group : no further symptomatic OVCFs after the initial PVP, "new symptomatic fracture" group: with newly developed symptomatic OVCF). Statistical analysis was performed between the variables of the two groups. Survival analysis was performed using the Kaplan-Meier method. Over all, 38 among 244 treated patients (15.6%) had experienced newly developed symptomatic OVCF(s) during the follow up period (mean 52.5 months). Old age and the presence of multiple treated vertebrae at the initial PVP were assessed as a strong parameter for predicting new symptomatic OVCF. With increasing preoperative wedging deformity the risk of developing new symptomatic OVCF decreased. The Kaplan-Meier estimate of the 1 year fracture-free rate was 92.2%. The Kaplan-Meier curve showed that 7.8% of the patients would experience new symptomatic OVCF within 1 year after initial PVP. A preoperative only mild wedge deformity of the fractured vertebra(e) could indicate the increased risk of developing new symptomatic OVCF after vertebroplasty.

Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty

“…This is still only a theory, however, and it is not clear whether there truly is an increased risk associated with vertebroplasty. Our results did not show an increased refracture rate, compared with reports of the natural course, which suggest that NVCFs that develop after vertebroplastic intervention might be the result of the osteoporosis itself, and not due to the intervention, as previous reports have pointed [11,21,25]. As for the risk of subsequent fracture after vertebroplasty, various causative factors have been proposed [7, 11, 13-15, 20, 21, 24].…”

“…Lindsay [12] reported the incidence of a NVCF in the subsequent year following an osteoporotic fracture to be 19.2%. Various studies have reported the 1-year NVCF rate after PVP or PKP to be 20.5% (Lin et al [14]), 21.7% (Syed et al [21], symptomatic), 7.8% (Lee et al [11], symptomatic), 7.9% (Kim et al [7]), and 15.5% (Moon et al [15]). In our study, which is larger in case population, the NVCF-free rate of 85.0% over 1 year is comparable to these data; however, our study was confined to only symptomatic subsequent NVCFs.…”

“…Several studies have reported an increase in the incidence of NVCF after bone cement augmentation, compared with conservative treatment [6,10,25]. The proposed risk factors include the amount of injected bone cement, intradiscal leakage, compact and solid cement pattern, and greater kyphosis correction [7,9,11,[13][14][15][20][21][22][23].…”

Adjacent Level Vertebral Fractures in Patients Operated with Percutaneous Vertebroplasty

“…Numerous risk factors have been reported for the occurrence of new adjacent VCFs after PVP, including growing age, previous vertebral fractures [16], steroids [30], vertebroplasty at the TL junction [15], low bone mineral density, proximity to the initial fracture site cement leakage into the discs [12] and vacuum clefts within the compression fracture [31].…”

A survey of the “medical” articles in the European Spine Journal, 2006

“…The paper by Lee et al [17] investigates the factors related to the development of new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. A retrospective review of 244 cases of PVP was performed.…”