Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures

Abstract

ObjectivePercutaneous vertebroplasty (PVP) is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs). The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery.Patients and methodsA total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group), and 122 patients had no recompression observed during the follow-up period (control group). Statistical analysis was performed to compare clinical and operative parameters between these two groups.ResultsDifferences were found in bone cement distribution between the recompression group and control group (P=0.001). Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients), when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body). The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003).ConclusionWe herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF.

Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study

“…Ahn et al 21 found that differences in vertebral body strength caused by bone cement augmentation resulted in fractures of adjacent vertebral bodies, while the difference in segmental mobility caused fractures of non-adjacent vertebral bodies. Recently, Zhang et al 22 showed that vertebral body augmentation does not increase untreated vertebral fractures. Compared with the patients in the OOVF group, the preoperative bone mineral density of patients in the N-OOVF group was worse, and the postoperative adjacent vertebral fracture rate in the OOVF group was lower than in the N-OOVF group.…”

An innovative technique for osteoporotic vertebral compression fractures – vertebral osteotome with side-opening cannula

“…Zhang et al found that patients with bone cement distributed around both the upper and lower endplates had the lowest rate of experiencing recompression compared to other patterns of bone cement distribution. 24 Previous studies showed that a larger bone–cement interface would achieve a relatively higher vertebral strength and reduce leakage rate. 25 It was suggested that the cement should spread through the vertebral body in a controlled manner that appeared fluoroscopically as a “uniformly expanding cloud” 26 .…”

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

“…There have been studies examining if the location, amount, and type of cement injected affected the outcome of vertebral augmentation. The distribution of cement is important since failure to obtain an adequate spread of the cement into the fractured area and specifically near the fractured endplates may lead to further collapse [ 19 ]. Even hemivertebral filling does not affect the risk of recurrent fractures at adjacent levels [ 20 ].…”

“…This highlights that the surgeon needs to make sure the injected cement gets to the area of the fracture, the involved endplate, and the edematous part of the vertebra. Studies have shown that low volumes (up to three cc of cement) are sufficient to stabilize the compression if well distributed, especially along the fractured endplates [ 8 , 17 , 19 - 20 ]. In repeat cases, both the superior and inferior endplates should be treated to provide complete support to progressively collapsing vertebrae (Figure 4 ).…”