The Risk of New Osteoporotic Vertebral Compression Fractures in the Year after Percutaneous Vertebroplasty

https://doi.org/10.1097/01.RVI.0000190910.43602.3CGet rights and content

PURPOSE

To prospectively assess the incidence, location, and possible causative mechanisms of new vertebral compression fractures (VCFs) in 66 symptomatic patients with osteoporotic VCFs treated with percutaneous vertebroplasty (PV) and to study the relation between new VCFs and back pain symptoms.

MATERIALS AND METHODS

Sixty-six patients with 102 painful symptomatic VCFs were treated with PV. All patients had baseline total spinal magnetic resonance (MR) imaging. Follow-up MR imaging was performed at 3, 6, and 12 months to locate new VCFs. Visual analog scales for pain and pain medication consumption were used to assess clinical outcomes. The following characteristics were compared in patients with new VCFs after PV versus patients without new VCFs: patient age, sex, presence of secondary osteoporosis, bone mineral density, number of preexisting VCFs, shape and grade of VCFs, type of bone cement used for PV, volume of injected cement, and cement leakage in intervertebral disc spaces.

RESULTS

Sixteen of 66 patients had 26 new VCFs during 1 year of follow-up after PV. Most new VCFs occurred within 3 months of PV, half of new VCFs appeared in levels adjacent to treated levels, and half of the new VCFs were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF.

CONCLUSION

New VCFs occurred after PV in 24% of patients. Half of new VCFs occurred in levels adjacent to treated levels and half were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF.

Section snippets

Patients

Between March 2002 and March 2004, 77 consecutive patients underwent PV of painful osteoporotic VCFs in our hospital. Eleven patients were excluded from the study. One patient died of unrelated disease within 2 months. Ten patients refused 3-month and/or 6-month follow-up MR imaging and were excluded from the study. The remaining 66 patients had 6-month follow-up MR imaging after PV and constitute the current study population. PV was performed only if conservative treatment had failed and back

RESULTS

The 66 patients treated with PV had a total of 228 preexisting VCFs with a median of three VCFs per patient (range, 1–10). Of these 228 VCFs, 102 showed bone marrow edema on MR imaging and were subsequently treated with PV in 68 sessions. Two patients were treated in two PV sessions.

There were no technical failures and there was no procedural morbidity. Injected bone cements included Simplex-P, Palacos LV-40, Osteopal V, and Osteo-Firm in 15, 28, 29, and 30 VCFs, respectively. All 66 patients

DISCUSSION

Nearly 25% of patients developed one or more new VCFs in the 1 year of follow-up after treatment of painful osteoporotic VCFs with PV. The majority of these new VCFs occurred within 3 months after PV. In the first 3 months, most new VCFs were located at adjacent levels, whereas later in follow-up, more distant levels were involved. Almost half of new VCFs were symptomatic. Presence of more than two preexisting VCFs was the only predictor in the development of new VCFs. Age, sex, presence of

References (25)

  • A Polikeit et al.

    The effect of cement augmentation on the load transfer in an osteoporotic functional spine unit

    Spine

    (2003)
  • F Grados et al.

    Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

    Rhematology (Oxford)

    (2000)
  • Cited by (172)

    • Percutaneous Vertebral Body Augmentations: The State of Art

      2019, Neuroimaging Clinics of North America
    View all citing articles on Scopus

    None of the authors have identified a conflict of interest.

    View full text