Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Abstract

Study Design. A case-control study.Objective. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Summary of Background Data. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. Methods. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. Results. 93 patients followed up for a mean duration of 25.1 months (12 -96) had a mean age of 76.8 years (47 -99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of À2.860 (95% confidence interval À3.268 to À2.452) and nonfractured vertebra had a mean T-score of À2.180 (95% confidence interval À2.373 to À1.986). A T-score of À2.2 or lower is predictive of refracture at that vertebra (P ¼ 0.047). Odds ratio increases with decreasing T-scores from À2.2 or lower to À2.6 or lower. A T-score of À2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P ¼ 0.049) and loss of preoperative anterior vertebral height (P ¼ 0.017) are associated with refracture. Conclusion. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower Tscores from À2.2 or less to À2.6 or less. They have a low positive predictive value, but a high negative predictive value for subsequent fractures. Other significant associations with subsequent refractures include age and anterior vertebral height.

<p>12-Month Teriparatide Treatment Reduces New Vertebral Compression Fractures Incidence And Back Pain And Improves Quality Of Life After Percutaneous Kyphoplasty In Osteoporotic Women</p>

“…Like previous research,36 a significant founding in this study was that the risk of NVCFs was closely related to the dose of glucocorticoids usage. Several studies also have suggested that individuals with lower baseline BMD of the lumbar spine are at greater risk of new fractures after vertebroplasty (Attachment 1) 37. A person with a severe osteoporotic spine may tolerate altered biomechanics poorly and suffer gradual malformation of the general spine.…”

<p>Bracing after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fractures was not effective</p>

“…It is still unclear whether bracing after PVP could prevent postoperative complications and improve quality of life. According to the previous studies, risk factors, such as BMD, intervertebral cleft, volume of bone cement, and so on, were associated with collapse of vertebral body, osteonecrosis after PVP, and postoperative satisfaction 16,17. Certainly, OVCF with intervertebral cleft is an important indication for surgical treatment, and because the sample size of the patients without bracing after PVP with intervertebral cleft was small, it was not included in the study, and we will discuss this topic in our future research.…”

Percutaneous Vertebroplasty Does Not Increase the Incidence of New Fractures in Adjacent and Nonadjacent Vertebral Bodies

“…Lower baseline BMD was considered one of the most important risk factors for new fractures 43,44. Several studies have suggested that BMD is associated with an increased rate of adjacent-level fractures.…”