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Research ArticleSPINE

Vertebroplasty: Cement Leakage into the Disc Increases the Risk of New Fracture of Adjacent Vertebral Body

Edward P. Lin, Sven Ekholm, Akio Hiwatashi and Per-Lennart Westesson
American Journal of Neuroradiology February 2004, 25 (2) 175-180;
Edward P. Lin
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Sven Ekholm
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Akio Hiwatashi
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Per-Lennart Westesson
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Images of an 85-year-old woman with back pain.

    A, Pre-vertebroplasty sagittal view T1-weighted MR image shows bone marrow edema of T12.

    B, Pre-vertebroplasty sagittal view T2-weighted MR image shows bone marrow edema of T12.

    C, Sagittal view contrast-enhanced T1-weighted MR image shows enhancement, indicating an acute T12 compression fracture.

    D, Post-vertebroplasty sagittal view reformatted CT scan shows cement leakage into the T11–T12 disk.

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    Fig. 1.

    Continued

    E, Sagittal view T1-weighted MR image obtained 15 days later, when the patient returned with new pain, shows new bone marrow edema of T11.

    F, Sagittal view T2-weighted MR image obtained 15 days later, when the patient returned with new pain, shows new bone marrow edema of T11.

    G, Contrast-enhanced sagittal view T1-weighted MR image shows T11 enhancement, indicating a new acute T11 fracture.

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    Fig 2.

    Images of a 79-year-old man with back pain.

    A, Pre-vertebroplasty sagittal view T1-weighted MR image shows bone marrow edema of T12 and L1.

    B, Pre-vertebroplasty sagittal view T2-weighted MR image shows bone marrow edema of T12 and L1.

    C, Sagittal view contrast-enhanced T1-weighted MR image shows enhancement, indicating acute T12 and L1 compression fractures.

    D, Post-vertebroplasty sagittal view reformatted CT scan shows cement leakage (arrow) into the L1–L2 disk. Of note, leakage of cement into the T11–T12 disk also occurred. However, T11 was treated with vertebroplasty at the same time as T12 and T11 therefore could not be evaluated for a possible new fracture.

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    Fig 2.

    Continued

    E, Sagittal view T1-weighted MR image obtained 25 days later, when the patient returned with new pain, shows a focal area of new bone marrow edema of L2 (arrows).

    F, Sagittal view T2-weighted MR image obtained 25 days later, when the patient returned with new pain, shows a focal area of new bone marrow edema of L2 (arrows).

    G, Contrast-enhanced sagittal view T1-weighted MR image shows enhancement, indicating a new acute focal fracture of L2 superiorly. The new fracture (arrows) is located immediately adjacent to the cement leakage into the disk.

Tables

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    TABLE 1:

    Patient characteristics

    Patients with Cement Leakage into the Disk during Vertebroplasty (n = 18)Patients with No Cement Leakage into the Disk during Vertebroplasty (n = 20)
    Average age (yr)7480
     Range (yr)45–8956–94
    Sex
     Male85
     Female1015
    Cause
     Osteoporosis1517
     Metastatic disease33
    • View popup
    TABLE 2:

    Incidence of new fractures in relationship to cement leakage into the disk (n = 38 patients)

    Fracture during Follow-up PeriodCement Leakage into DiskNo Cement Leakage into DiskTotal
    No new fracture81624
    New fracture10414
    Total (P = .018)182038
    • View popup
    TABLE 3:

    Incidence of new fractures in relationship to cement leakage into the disk (n = 109 disks with adjacent vertebral bodies that potentially could fracture; no previous treatment or fracture)

    Fracture during Follow-up PeriodCement Leakage into DiskNo Cement Leakage into DiskTotal
    No new fracture111122
    New fracture87987
    Total (P < .0005)1990109
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American Journal of Neuroradiology: 25 (2)
American Journal of Neuroradiology
Vol. 25, Issue 2
1 Feb 2004
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Vertebroplasty: Cement Leakage into the Disc Increases the Risk of New Fracture of Adjacent Vertebral Body
Edward P. Lin, Sven Ekholm, Akio Hiwatashi, Per-Lennart Westesson
American Journal of Neuroradiology Feb 2004, 25 (2) 175-180;

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Vertebroplasty: Cement Leakage into the Disc Increases the Risk of New Fracture of Adjacent Vertebral Body
Edward P. Lin, Sven Ekholm, Akio Hiwatashi, Per-Lennart Westesson
American Journal of Neuroradiology Feb 2004, 25 (2) 175-180;
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  • Teriparatide and Raloxifene Reduce the Risk of New Adjacent Vertebral Fractures in Postmenopausal Women with Osteoporosis: Results from Two Randomized Controlled Trials
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