Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty

Kim, S. H.; Kang, Heung Sik; Choi, Jung-Ah; Ahn, Joong Mo

doi:10.1080/02841850410005615

Cited by 236 publications

(72 citation statements)

References 15 publications

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“…A lordotic force carries the risk of unsuspected damage to the adjacent vertebral pedicle and facet joints. The risk of latent complications, such as cement leakage and pulmonary embolism, may increase with increasing number of treated vertebra [24,25]. In the present study, computed-tomography showed no injury to the adjacent vertebral structures after LP on the postoperative scan.…”

Section: Discussionsupporting

confidence: 53%

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

et al. 2010

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Study DesignA retrospective study.PurposeTo compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty.Overview of LiteratureKyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced.MethodsBetween 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction.ResultsAll patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0° in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5° after 3 months.ConclusionsLordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.

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Section: Discussionsupporting

confidence: 53%

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

et al. 2010

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“…In addition, increased anterior vertebral height restoration is one of the well-known risk factor of VCFs. In particular, it increases the risk of the newly formed VCFs because of the restoration of vertebral height, and greater loading of adjacent vertebra16). Although this study did not showe significant differences between the no fractures group and adjacent fractures group, the fracture can increase due to the dynamic hammer effect in the same mechanism with cement intradiscal leakage, since the anterior vertebral restoration affect the development of remote segmental fractures in the comparison with nonadjacent fractures group.…”

Section: Discussionmentioning

confidence: 52%

“…The causes of new-onset fractures after vertebroplasty are still debated : progression of the underlying disease3,20,21), augmentation of implanted cements, increased physical activity11,16,18,27) are possible contributors. The pertinent question regarding new-onset fractures after vertebroplasty is whether the next fracture level could be predicted.…”

Section: Introductionmentioning

confidence: 99%

The Analysis of Patterns and Risk Factors of Newly Developed Vertebral Compression Fractures after Percutaneous Vertebroplasty

Yoo

Park

Hwang

et al. 2012

J Korean Neurosurg Soc

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ObjectiveThe purpose of this study was to investigate the patterns and the risk factors of newly developed vertebral compression fractures (VCFs) after percutaneous vertebroplasty (PVP).MethodsWe performed a retrospective review of the 244 patients treated with PVP from September 2006 to February 2011. Among these patients, we selected 49 patients with newly developed VCFs following PVP as the new VCFs group, and the remaining 195 patients as the no VCFs group. The new VCFs group was further divided into 2 groups : an adjacent fractures group and a nonadjacent fractures group. The following data were collected from the groups : age, gender, body weight/height, body mass index (BMI), bone mineral density (BMD) score of the spine and femur, level of initial fracture, restoration rate of anterior/middle vertebral height, and intradiscal cement leakage, volume of polymethylmethacrylate (PMMA).ResultsAge, gender, mean body height/weight, mean BMI and volume of PMMA of each of the group are not statistically significantly associated with fractures. In comparison between the new VCFs group and the no VCFs group, lower BMD, intradiscal cement leakage and anterior vertebral height restoration were the significant predictive factors of the fracture. In addition, new VCFs occurrence at the adjacent spines was statistically significant, when the initial fracture levels were confined to the thoracolumbar junction, among the subgroups of new VCFs.ConclusionLower spinal BMD, the greater anterior vertebral height restoration rate and intradiscal cement leakage were confirmed as risk factors for newly formed VCFs after PVP.

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“…Some studies have concluded that the outcome was mainly due to procedure-related complications such as cement leakage or adjacent vertebral fracture, without considering pre-operative factors. 27,28 Other studies that identified pre-operative prognostic factors only focused on the post-operative pain improvement within the vertebroplasty group without comparison with the conservative group. 29-31 Conservative treatment including a rigid brace and painkillers is still the treatment of choice in OVCFs.…”

Section: Discussionmentioning

confidence: 99%

Increased sagittal vertical axis is associated with less effective control of acute pain following vertebroplasty

et al. 2016

Bone & Joint Research

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ObjectivesAlthough vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients.Patients and MethodsPatients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.ResultsA total of 342 patients finished the 12-week follow-up, and 120 patients underwent vertebroplasty (35.1%). The effect of vertebroplasty over conservative treatment was significant regardless of age, body mass index, medical comorbidity, previous fracture, pain duration, bone mineral density, degree of vertebral body compression, and canal encroachment. However, the effect of vertebroplasty was not significant at all time points in patients with increased sagittal vertical axis.ConclusionsFor single-level acute osteoporotic vertebral compression fractures, the effect of vertebroplasty was less favourable in patients with increased sagittal vertical axis (> 5 cm) possible due to aggravation of kyphotic stress from walking imbalance.Cite this article: Y-C. Kim, D. H. Bok, H-G. Chang, S. W. Kim, M. S. Park, J. K. Oh, J. Kim, T-H. Kim. Increased sagittal vertical axis is associated with less effective control of acute pain following vertebroplasty. Bone Joint Res 2016;5:544–551. DOI: 10.1302/2046-3758.511.BJR-2016-0135.R1.

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Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty

Abstract: Thoracolumbar junction, shorter distance from the treated vertebrae, and greater degree of height restoration of the cemented vertebrae may increase the fracture risk of vertebrae adjacent to cement vertebrae after vertebroplasty.

Cited by 236 publications

References 15 publications

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

The Analysis of Patterns and Risk Factors of Newly Developed Vertebral Compression Fractures after Percutaneous Vertebroplasty

Increased sagittal vertical axis is associated with less effective control of acute pain following vertebroplasty

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