Premature Adjacent Vertebral Fracture After Vertebroplasty: A Biomechanical Study

Fahim, Daniel K.; Sun, Kay; Tawackoli, Wafa; Mendel, Ehud; Rhines, Laurence D.; Burton, Allen W.; Kim, Daniel H.; Ehni, Bruce L.; Liebschner, Michael A. K.

doi:10.1227/neu.0b013e31821cc499

Cited by 29 publications

(25 citation statements)

References 48 publications

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“…The optimal amount of injected bone cement is controversial. Vertebroplasty alters the load transfer along the anterior spinal column, significantly increasing the fracture risk and ultimately leading to load failure of the untreated adjacent vertebrae [13]. It is generally advocated to inject as much bone cement as possible without leakage to enhance vertebral strength.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…lower both the failure load and the stiffness of the end plate (36) and the anterior wedge deformities of the vertebral body may start with endplate damage (37,38). We believe that a prolonged waiting time before repair may also lead to end plate injury during normal activity; thus, after vertebroplasty has been performed, the incidence of AVF may accelerate.…”

Section: Discussionmentioning

confidence: 99%

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

Lee

2018

Pain Phys

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Background: Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the development of adjacent vertebral fractures (AVF) has rarely been discussed. Objective: This study aimed to compare the incidence of AVF among patients who received early PVP (≤ 30 days after symptom onset, EPVP) or late PVP (> 30 days after symptom onset, LPVP) in the thoracolumbar region (T10 to L2) after a 1-year follow up. Study Design: A retrospective cohort study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: Patients who had single-level, T-score ≤ -2.5 of lumbar bone mineral density (BMD), primary OVCF in the thoracolumbar region (T10 to L2) and who received PVP between July 2012 and June 2014 were included in the study. They were divided into early PVP and late PVP groups according to the interval between symptom onset and treatment. The risk factors associated with subsequent AVFs were analyzed. Results: Of the 225 patients reviewed, 124 met the criteria and were followed for a minimum of 1 year. Eleven patients (14.1%) in the EPVP group (n = 78) and 18 patients (39.1%) in the LPVP group (n = 46) experienced an AVF during the first year following vertebroplasty. Outcomes were significantly better in patients with higher bone mineral density, lower cement volume, and without cement leakage (P < 0.01). Cox regression indicated an increase risk for AVF for LPVP, with an adjusted hazard ratio of 6.08 (95% confidence interval: 2.50–14.81). Limitation: The incidence of AVFs could be over estimated due to this being a retrospective study with a small case number and lack of either biomechanical study of intra-vertebral cement distribution by times to support the result. Conclusions: Compared with later interventions, PVP performed within 30 days after fracture development may be associated with a lower risk of adjacent fractures in the thoracolumbar region. Key words: Percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression fracture, adjacent vertebral fracture

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“… 17 , 18 , 19 , 20 , 21 , 22 The mechanism of adjacent level fractures was searched by several biomechanical studies. 8 , 9 , 11 , 23 , 24 In their biomechanical study Fahim et al claimed that the endplate deflection fracture mechanism was the main factor for adjacent fractures after vertebroplasty and concluded that vertebroplasty altered the load transfer along the anterior spinal column. 8 Similarly, Baroud et al hypothesized that excess deformation in the adjacent endplate essentially contributed to subsequent adjacent fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Fahim et al suggested that aggressive cement augmentation of the vertebral body may promote the endplate deflection fracture mechanism. 8 Biomechanical and finite element studies demonstrated that vertebroplasty alters load transfer, resulting in increased stresses in adjacent endplates as well. 9 , 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer

Gasbarrini¹,

Ghermandi²,

Akman³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectivePercutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure.Materials and methodsThirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38–84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded.ResultsThe mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000).ConclusionsElastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures.Level of evidenceLevel IV, therapeutic study.

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Premature Adjacent Vertebral Fracture After Vertebroplasty: A Biomechanical Study

Cited by 29 publications

References 48 publications

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

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

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer

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