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AJNR - American Journal of Neuroradiology

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New Fractures after Vertebroplasty: Adjacent Fractures Occur Significantly Sooner

A.T. Trout^a, D.F. Kallmes^b and T.J. Kaufmann^b

^a Mayo Clinic College of Medicine, Rochester, Minn
^b Department of Radiology, Mayo Clinic Rochester, Rochester, Minn

View larger version (39K): [in a new window]   Fig 1. Location of prevalent and incident vertebral fractures. Two nonexclusive groups of incident fractures are shown—incident fractures following only the first vertebroplasty in a given patient and incident fractures following all vertebroplasties in a given patient. All data are shown as a percentage of that group of fractures. The distribution of prevalent fractures is bimodal with peaks around T8–T9 and T12–L1, with L1 as the most-common prevalent fracture location. The distributions of both groups of incident fractures were significantly different from the distribution of prevalent fractures with essentially a uniform distribution across the spine. There was no significant difference in the distributions of the 2 incident fracture groups.

View larger version (39K): [in a new window]   Fig 2. Distribution of prevalent and adjacent and nonadjacent incident fractures. The distribution of adjacent- and nonadjacent-level fractures is significantly different. Adjacent-level fractures predominate at the thoracolumbar junction (T11–L2), whereas nonadjacent-level fractures predominate in the midthoracic region of the spine (T7–T9).

View larger version (18K): [in a new window]   Fig 3. Survival curve depicting time incident of adjacent- and nonadjacent-level fractures in our patient population. Fractures adjacent to treated levels occur significantly sooner than fractures of nonadjacent vertebral bodies.

View larger version (17K): [in a new window]   Fig 4. Time from PVP to new fracture versus distance from PVP to new fracture. The distance from prior PVP to a new, incident fracture decreases as time from PVP to the incident fracture decreases as indicated by the simple linear regression line (estimate, 33.8; SE, 8.9; P = .0002).

View larger version (15K): [in a new window]   Fig 5. Survival curve depicting time to new fracture based on data from Uppin et al.21 Although not statistically significant, fractures of vertebrae adjacent to treated levels trend toward occurring sooner than fractures of nonadjacent levels.