Skip to main content
Log in

Newly developed compression fractures after percutaneous vertebroplasty: comparison with conservative treatment

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate the incidence and timing of subsequent fractures in patients treated with and without percutaneous vertebroplasty (PVP).

Materials and methods

We reviewed 794 patients who underwent 1500 PVPs with polymethylmethacrylate (PMMA) at our institution between January 1999 and December 2009. We also reviewed 349 patients with vertebral fractures who underwent conservative treatment without PVP between October 1999 and December 2009 and compared the incidence and timing of subsequent fractures in the two groups.

Results

Among the 794 patients treated by PVP, 171 (21.5%) suffered 336 new vertebral fractures. Among the patients not treated by PVP, 82 (23.5%) presented with 154 new fractures. There was no statistically significant difference (P = 0.46). Among the PVP-treated patients, one-half of new fractures occurred at a level adjacent to the treated level, and they occurred significantly sooner than nonadjacent level fractures (log-rank test, P < 0.01).

Conclusion

PVP did not increase the incidence of new compression fractures compared with conservative treatment, but half of the new fractures at the adjacent vertebral bodies occurred sooner.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lin JT, Lane JM. Osteoporosis: a review. Clin Orthop 2004;425:126–134.

    Article  PubMed  Google Scholar 

  2. Melton LJ III. Epidemiology of spinal osteoporosis. Spine 1997;22(suppl 24):2S–11S.

    Article  PubMed  Google Scholar 

  3. Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987;33:166–168.

    PubMed  CAS  Google Scholar 

  4. Jenson ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 1997;18:1897–1904.

    Google Scholar 

  5. Higgins KB, Harten RD, Langrana NA, Reiter MF. Biomechanical effects of unipedicular vertebroplasty on intact vertebrae. Spine 2003;28:1540–1547; discussion 1548.

    PubMed  Google Scholar 

  6. Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 2004;45:440–445.

    Article  PubMed  CAS  Google Scholar 

  7. Uppin A, Hirsch J, Centenera L, Pfiefer B, Pazianos A, Choi I. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003;226:119–124.

    Article  PubMed  Google Scholar 

  8. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 2006;27:217–223.

    PubMed  CAS  Google Scholar 

  9. Huskisson EC. Measurement of pain. Lancet 1974;2:1127–1131.

    Article  PubMed  CAS  Google Scholar 

  10. Martin JB, Jean B, Sugiu K, San Millan Ruiz D, Piotin M, Murphy K, et al. Vertebroplasty: clinical experience and follow-up results. Bone 1999;25(suppl):11S–15S.

    Article  PubMed  CAS  Google Scholar 

  11. McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow up. J Vasc Interv Radiol 2002;13:883–886.

    Article  PubMed  Google Scholar 

  12. Do HM, Kim BS, Marcellus ML, Curtis L, Marks MP. Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR Am J Neuroradiol 2005;26:1623–1628.

    PubMed  Google Scholar 

  13. Hochmuth K, Proschek D, Schwarz W, Mack M, Kurth AA, Vogl TJ. Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review. Eur Radiol 2006;5:1–7.

    Google Scholar 

  14. Evans AJ, Jenson ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplastyretrospective report of 245 cases. Radiology 2003;226:366–372.

    Article  PubMed  Google Scholar 

  15. Dean JR, Ison KT, Gishen P. The strengthening effects of percutaneous vertebroplasty. Clin Radiol 2000;55:471–476.

    Article  PubMed  CAS  Google Scholar 

  16. Deramond H, Debussche C, Pruvo JP, Galibert P. La vertebroplastie. Feuillets Radiol 1990;30:262–268.

    Google Scholar 

  17. Wasnich RD. Vertebral fracture epidemiology. Bone 1996;18(suppl 3):179S–183S.

    Article  PubMed  CAS  Google Scholar 

  18. Ananthakrishnan D, Berven S, Deviren V, Cheng K, Lotz JC, Xu Z, et al. The effect on anterior column loading due to different vertebral augmentation techniques. Clin Biomech (Bristol, Avon) 2005;20:25–31.

    Article  Google Scholar 

  19. Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 2003;28:991–996.

    PubMed  Google Scholar 

  20. Wilcox RK. The biomechanical effect of vertebroplasty on the adjacent vertebral body: a finite element study. Proc Inst Mech Eng H 2006;220:565–572.

    Article  PubMed  CAS  Google Scholar 

  21. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001;285:320–323.

    Article  PubMed  CAS  Google Scholar 

  22. Heini PF, Walchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results—a prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 2000;9:445–450.

    Article  PubMed  CAS  Google Scholar 

  23. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increase the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 2004;25:175–180.

    PubMed  Google Scholar 

  24. Grados F, Depriestre C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000;39:1410–1414.

    Article  CAS  Google Scholar 

  25. Voormolen MH, Lohle PN, Juttmann JR, Graaf Y, Fransen H, Lampmann LE. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 2006;17:71–76.

    Article  PubMed  Google Scholar 

  26. Tanigawa N, Komemushi A, Kariya S, Kojima H, Shomura Y, Sawada S. Radiological follow-up of new compression fractures following percutaneous vertebroplasty. Cardiovasc Intervent Radiol 2006;29:92–96.

    Article  PubMed  Google Scholar 

  27. Tseng YY, Yang TC, Tu PH, Lo YL, Yang ST. Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty. Spine (Phila Pa 1976) 2009;34:1917–1922.

    Article  Google Scholar 

  28. Hierholzer J, Fuchs H, Westphalen K, Baumann C, Slotosch C, Schulz R. Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Intervent Radiol 2008;31:1178–1183.

    Article  PubMed  Google Scholar 

  29. Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, et al. Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 2006;29:580–585.

    Article  PubMed  Google Scholar 

  30. Berlemann U, Ferguson SJ, Nolte LP, Heini PF. Adjacent vertebral failure after vertebroplasty: a biomechanical investigation. J Bone Joint Surg Br 2002;84:748–752.

    Article  PubMed  CAS  Google Scholar 

  31. Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty: the effect of cement volume on mechanical behavior. Spine 2001;26:1537–1541.

    Article  PubMed  CAS  Google Scholar 

  32. Mirovsky Y, Anekstein Y, Shalmon E, Peer A. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol 2005;26:1634–1640.

    PubMed  Google Scholar 

  33. Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ. Prediction of osteoporotic spinal deformity. Spine (Phila Pa 1976) 2003;28:455–462.

    Google Scholar 

  34. Kelekis AD, Martin JB. Radicular pain after vertebroplasty: complication and prevention. Skeletal Radiol 2005;34:816.

    Article  PubMed  Google Scholar 

  35. Teng MM, Cheng H, Ho DM, Chang CY. Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases. AJNR Am J Neuroradiol 2006;27:224–229.

    PubMed  CAS  Google Scholar 

  36. Harrington KD. Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate: a case report. J Bone Joint Surg Am 2001;83:1070–1073.

    PubMed  Google Scholar 

  37. Cosar M, Sasani M, Oktenoglu T, Kaner T, Ercelen O, Kose KC, et al. The major complications of transpedicular vertebroplasty. J Neurosurg Spine 2009;11:607–613.

    Article  PubMed  Google Scholar 

  38. Freitag M, Gottschalk A, Schuster M, Wenk W, Wiesner L, Standl TG. Pulmonary embolism caused by polymethylmethacrylate during percutaneous vertebroplasty in orthopaedic surgery. Acta Anaesthesiol Scand 2006;50:248–251.

    Article  PubMed  CAS  Google Scholar 

  39. Baumann A, Tauss J, Baumann G, Tomka M, Hessinger M, Tiesenhausen K. Cement embolization into the vena cava and pulmonal arteries after vertebroplasty: interdisciplinary management. Eur J Vasc Endovasc Surg 2006;31:558–561.

    Article  PubMed  CAS  Google Scholar 

  40. Pitton MB, Herber S, Koch U, Oberholzer K, Drees P, Duber C. CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures. Eur Radiol 2008;18:2568–2578.

    Article  PubMed  Google Scholar 

  41. Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 2002;96(suppl):56–61.

    PubMed  Google Scholar 

  42. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 2001;26:1547–1554.

    Article  PubMed  CAS  Google Scholar 

  43. Kumar K, Verma AK, Wilson J, LaFontaine A. Vertebroplasty in osteoporotic spine fractures: a quality of life assessment. Can J Neurol Sci 2005;32:487–495.

    PubMed  Google Scholar 

  44. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009;361:557–568.

    Article  PubMed  CAS  Google Scholar 

  45. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361:569–579.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Keigo Chosa.

About this article

Cite this article

Chosa, K., Naito, A. & Awai, K. Newly developed compression fractures after percutaneous vertebroplasty: comparison with conservative treatment. Jpn J Radiol 29, 335–341 (2011). https://doi.org/10.1007/s11604-011-0564-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-011-0564-z

Key words

Navigation