Radiological Follow-up of New Compression Fractures Following Percutaneous Vertebroplasty

Abstract

The purpose of the present study was to ascertain chronological changes in the analgesic effects of percutaneous vertebroplasty (PVP) on osteoporotic vertebral compression fractures and to radiologically follow new compression fractures after PVP. Seventy-six patients (206 vertebral bodies) were followed radiologically for a mean of 11.5 months. A visual analog scale (VAS; 0-10) was used to assess pain severity, and frontal and lateral plain radiographs of the thoracic and lumbar vertebrae were taken 1-3 days and 1, 4, 10, and 22 months after PVP. The average VAS score was 7.2 +/- 2.0 (mean pain score +/- standard deviation) before PVP, 2.5 +/- 2.3 at 1-3 days after PVP, 2.2 +/- 2.3 at 1 month, 1.9 +/- 2.2 at 4 months, 1.8 +/- 2.4 at 10 months, and 1.0 +/- 0.2 at 22 months. A new compression fracture was confirmed in 56 vertebral bodies in 28 patients (36.8%), affecting 38 adjacent vertebral bodies (67.8%), 17 nonadjacent vertebral bodies (30.4%), and 1 treated vertebral body (1.8%). A new compression fracture occurred within 1 week of PVP in 2 vertebral bodies (3.6%), between 1 week and 1 month after PVP in 22 (39.3%), between 1 and 3 months in 12 (21.4%), between 3 and 6 months in 12 (21.4%), and after more than 6 months in 8 (14.3%). PVP was highly effective in relieving the pain associated with osteoporosis-induced vertebral compression fractures, and this analgesia was long lasting. Radiological follow-up observation revealed new compression fractures in about one-third of patients. More than half of these new compression fractures occurred in adjacent vertebral bodies within 3 months of PVP.

Long-term prospective study of osteoporotic patients treated with percutaneous vertebroplasty after fragility fractures

“…A non-randomized controlled study reported a 24% incidence of new vertebral fractures after 2 years, comparable to that of patients treated conservatively [2]. Uncontrolled prospective [9][10][11][12] and retrospective [13] studies reported an incidence of fractures after PVP that ranges from 17% to 37% within 1 year of follow-up, and a retrospective population-based cohort study showed an increased rate of fracture with respect to patients not treated with PVP (18.9% and 9.8% after 1 year, respectively) [14]. In general, these findings are difficult to interpret because of the different population studied, the short follow-up period, and the lack of information about parameters of bone density and metabolism of the patients who underwent PVP and about antiosteoporotic medications after the procedure.…”

Percutaneous vertebroplasty: the follow-up

“…The method's high sensitivity and low cost in economic and biological terms justifies adoption of this follow-up protocol by the various centres offering vertebroplasty. Other follow-up imaging modalities have already been reported in the literature, but their use is aimed at studying the treated spine only [31]. [31].…”

“…Other follow-up imaging modalities have already been reported in the literature, but their use is aimed at studying the treated spine only [31]. [31].…”

Percutaneous Vertebroplasty Under Three-Dimensional Radiography Guidance -Technical Note-

“…However, the long-term effects of PVP remain controversial. 7,8,10,15) Several studies have reported new compression fractures in adjacent vertebrae after PVP.…”