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AJNR - American Journal of Neuroradiology

Published ahead of print on July 30, 2009
doi: 10.3174/ajnr.A1722

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American Journal of Neuroradiology 30:1830-1834, November-December 2009
© 2009 American Society of Neuroradiology

SPINE

Subsequent Fracture after Percutaneous Vertebroplasty Can Be Predicted on Preoperative Multidetector Row CT

A. Hiwatashi^a, T. Yoshiura^a, K. Yamashita^a, H. Kamano^a, T. Dashjamts^a and H. Honda^a

^aFrom the Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Please address correspondence to Akio Hiwatashi, MD, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; e-mail: hiwatasi{at}radiol.med.kyushu-u.ac.jp

BACKGROUND AND PURPOSE: Subsequent fracture is often seen after percutaneous vertebroplasty. The purpose of this prospective study was to evaluate preoperative multidetector row CT (MDCT) for the prediction of subsequent fractures after vertebroplasty.

MATERIALS AND METHODS: This study included 26 consecutive patients (18 women and 8 men) with osteoporotic compression fractures (58 vertebrae). A 64-section MDCT with multiplanar reformation was obtained 1 day before the procedure. Subsequent MR imaging was used to evaluate new fractures at least 3 months after treatment on a routine basis or if there was recurrent pain. We used logistic regression analysis with MDCT findings and clinical data for statistical evaluation according to the location of new fractures.

RESULTS: Subsequent fractures were noted at 14 adjacent vertebrae (12.1%) in 13 patients and at 14 remote vertebrae in 6 patients (23.1%). Subsequent fractures in adjacent vertebrae tended to occur in small vertebrae before treatment (P < .05). Steroid medication and low CT value in nonfractured vertebrae were associated with subsequent fractures in remote vertebrae (P < .05). Further collapse of the treated vertebral bodies was noted in 10 patients (11 vertebrae [19.0%]) without specific findings (P > .05).

CONCLUSIONS: The small size of the treated vertebrae may relate to subsequent fractures in adjacent vertebrae. Steroid use and low CT value of nonfractured vertebrae on preoperative MDCT can be associated with subsequent fractures in remote vertebrae.