Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to evaluate the predictive factors for subsequent vertebral fracture occurring after percutaneous vertebroplasty (PVP) at the neighboring levels (adjacent vs nonadjacent levels).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The medical records of 508 consecutive patients treated with PVP between January 2000 and December 2002 were retrospectively reviewed. A total of 45 patients with 49 painful vertebral fractures occurring after PVP was identified based on clinical and radiological findings. New vertebral fractures, developing at any of the 3 consecutive vertebral bodies (VBs) above or below the previously treated level, were the focus of the study. The patients were divided into 3 groups: an adjacent-level fracture group, nonadjacent-level fracture group, and a control group composed of 50 randomly selected patients in whom there was no evidence of a new fracture. Clinical, imaging, and procedure-related factors for each group were statistically analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In 31 patients 35 VBs were classified as adjacent-level fractures, and in 14 patients 14 VBs were classified as nonadjacent-level fractures. After further vertebroplasty, the overall pain intensity and satisfaction rate in patients with post-PVP fractures were similar to those in the control group. In cases involving adjacent fractures, lower body mass index and intradiscal cement leakage were the significant predictive factors of fracture. In contrast, lower mobility of the index segment was related to nonadjacent-level fracture.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>According to the authors' results, the mechanisms of subsequent fracture at adjacent and nonadjacent vertebrae are different. A direct pillar effect (that is, the difference in strength caused by cement augmentation) may provoke an adjacent-level fracture, whereas a dynamic hammer effect (the difference in segmental mobility) may lead to a nonadjacent fracture.</jats:p></jats:sec>

The correlation between vertebral wedge-shaped changes in X-ray imaging at supine and standing positions and the efficacy of operative treatment of thoracolumbar spinal fracture in the elderly

“…20 Moreover, many reports agree with the fact that fracture risk of adjacent segment vertebra increases after vertebroplasty. [21][22][23] It has been reported that vertebroplasty should be performed for fewer than three vertebral bodies. 24 Fracture instability due to biomechanical change is the main reason for pain in VBCF, 25 and thus nonunion and unstable vertebrae are the therapeutic subjects.…”

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

“…Various reasons and risk factors for fractures that occur following VP have been discussed: increased stiffness in the vertebra treated [34,42], cement formation of a solid mass rather than interdigitation [43], changes in load transfer [44,45], an altered loading direction [46], cement leakage into the disc (pro: [12,14,21,[47][48][49], contra: [50]), use of too much cement [15,49], the degree of vertebral height restoration [12,15] and persistent local kyphosis [20], deflection of the endplate and the intervertebral disc into adjacent vertebra [34], fracture shape [51], pre-existing fracture [12,23], advanced patient age [23], ongoing osteoporosis [16,20,24], and low BMD [12,16,19,21,23], and a high number of VPs at baseline [16,26]. In addition, patients with high parathyroid hormone concentrations, low body mass index, no use of back brace, no anti-osteoporosis therapy, history of metabolic disease, and use of drugs which influence bone metabolism tend to have a greater risk of recurrent fractures [16,17,47].…”

“…In addition, patients with high parathyroid hormone concentrations, low body mass index, no use of back brace, no anti-osteoporosis therapy, history of metabolic disease, and use of drugs which influence bone metabolism tend to have a greater risk of recurrent fractures [16,17,47]. Studies on refractures of augmented vertebrae focused on the influence of vertebral height restoration, distribution patterns of cement in the augmented vertebra and intravertebral clefts [52], pre-operative osteonecrosis [18,53], fracture shape, loading case and elastic modulus of fracture region and cement [51].…”

“…Ahn et al [47] described the ''direct pillar effect (that is, the difference in strength caused by cement augmentation)'' as being responsible for subsequent vertebral fractures.…”

The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty

“…Furthermore, there are controversies regarding the optimal volume and location of the injected cement. Adjacent fractures are related to strength differences associated with cement augmentation, and non-adjacent fractures are due to differences in segmental mobility 1) . Increased vertebral strength after vertebroplasty can cause a spontaneous vertebral compression fracture without any obvious traumatic event 6) .…”