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Subsequent Vertebral Fractures after Vertebroplasty: Association with Intraosseous Clefts

A.T. Trouta, D.F. Kallmesb, J.I. Laneb, K.F. Laytonb and W.F. Marxc

a Mayo Clinic College of Medicine, Rochester, Minn
b Mayo Clinic Department of Radiology, Rochester, Minn
c Asheville Radiology Associates, Asheville, NC


Figure 1
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  		Fig 1. Prevertebroplasty MR imaging (A) and intraoperative fluoroscopic images (B and C) of the treated level in a patient with an intraosseous cleft. T2-weighted (repetition time [TR]/echo time [TE], 2800/102 fast spin-echo with fat-saturation) MR (A) demonstrates acute compression of L2 in this 82-year-old male patient. The arrow indicates a fluid-filled cleft within the fractured vertebra. The lateral (B) fluoroscopic image shows filling of the cleft in the anterior portion of the vertebral body with little trabecular pattern to the implanted cement. A more typical trabecular filling pattern is seen in the posterior aspect of the treated vertebral body on the lateral projection.


Figure 2
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  		Fig 2. Prevertebroplasty MR imaging (A) and intraoperative fluoroscopic images (B and C) of the treated level in a patient without an intraosseous cleft. T2-weighted (repetition time [TR]/echo time [TE], 3300/150 fast spin-echo, without fat saturation) MR (A) demonstrates acute compression of T12 in this 61-year-old male patient. Lateral (B) and anteroposterior (C) fluoroscopic images after vertebroplasty at T12 show cement evenly distributed among the trabeculae of the fractured vertebral body.


Figure 3
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  		Fig 3. Location of treated vertebrae divided based upon the presence or absence of clefts. Data are depicted as a percentage of each subgroup. The distribution of treated vertebrae is similar between patients with and without documented intraosseous clefts. In accordance with previous descriptions,4,13 there is an increased incidence of fractures and clefts at the thoracolumbar junction in our patient population.


Figure 4
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  		Fig 4. Location of subsequent vertebral fractures divided based upon the presence or absence of an intraosseous cleft in a previously treated vertebral level. Data are depicted as a percentage of each subgroup. The distribution of subsequent fractures is similar regardless of the presence or absence of a cleft in the previously treated level. In addition, no specific zone of the spine seems more likely to develop subsequent fractures.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X