CardioVascular and Interventional Radiology

, Volume 31, Issue 6, pp 1178–1183 | Cite as

Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

  • Johannes HierholzerEmail author
  • Heiko Fuchs
  • Kerstin Westphalen
  • Clemens Baumann
  • Christine Slotosch
  • Rudolf Schulz
Clinical Investigation


The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6–56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.


Vertebroplasty Osteoporosis Pain palliation Back pain Follow-up 


  1. 1.
    Newitt MC, Thompson DE, Black DM (2000) Effect of alendronate on limited activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Arch Intern Med 160:77–85CrossRefGoogle Scholar
  2. 2.
    Kado DM, Browner WS, Palermo L (1999) Vertebral fractures and mortality in older women: a prospective study. Arch Intern Med 159:1215–1220PubMedCrossRefGoogle Scholar
  3. 3.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fractures in the year following a fracture. JAMA 285:320–323PubMedCrossRefGoogle Scholar
  4. 4.
    Klotzbuechler CM, Ross PD, Landsmen PB (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRefGoogle Scholar
  5. 5.
    Galibert P, Deramond H, Rosat P, Le Gars D (1987) Note preliminaire sur le traitment des angiomes vertebraux par vertebroplastie acrylique percutanee. Neurochirurgie 233:166–168Google Scholar
  6. 6.
    Hierholzer J, Midiri M, Fuchs H (2003) Die perkutane Vertebroplastie. Dtsch Med Wochenschr 128:673–676PubMedCrossRefGoogle Scholar
  7. 7.
    Anselmetti GC, Corrao G, Monica PD, Tartaglia V, Manca A, Eminefendic H, Russo F, Tosetti I, Regge D (2007) Pain relief following percutaneous vertebroplasty: results of a series of 283 consecutive patients treated in a single institution. CardioVasc Interv Radiol 30:441–447CrossRefGoogle Scholar
  8. 8.
    Baumann C, Fuchs H, Kiwit J, Westphalen K, Hierholzer J (2007) Complications in percutaneous vertebroplasty associated with puncture or cement leakage. CardioVasc Interv Radiol 30:161–168CrossRefGoogle Scholar
  9. 9.
    Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A (2007) New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR 26:1601–1604Google Scholar
  10. 10.
    Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. CardioVasc Interv Radiol 29:580–585CrossRefGoogle Scholar
  11. 11.
    Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. J Bone Joint Surg (Br) 84b:748–752CrossRefGoogle Scholar
  12. 12.
    Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR 27:217–223PubMedGoogle Scholar
  13. 13.
    Hierholzer J, Westphalen K, Fuchs H, Baumann C (2008) Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Eur Radiol (Suppl) 18:297Google Scholar
  14. 14.
    Hierholzer J, Fuchs H, Westphalen K, Venz S, Papert D, Depriester C (2005) Percutaneous vertebroplasty—the role of osseous phlebography. Fortschr Röntgenstr 177:386–392CrossRefGoogle Scholar
  15. 15.
    Hierholzer J (2005) Interdisziplinäres Konsensuspapier zur Vertebroplastie/Kyphoplastie. Fortschr Röntgenstr 177:1590–1592Google Scholar
  16. 16.
    Wasnich RD (1996) Vertebral fracture epidemiology. Bone 18(Suppl):179S–183SCrossRefGoogle Scholar
  17. 17.
    Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG (2003) Occurrence of new vertebral body fractures after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124PubMedCrossRefGoogle Scholar
  18. 18.
    Kim SH, Kang HS, Choi JA (2004) Risk facrors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 46:440–445CrossRefGoogle Scholar
  19. 19.
    Rohlmann A, Zander T, Bergmann G (2005) Comparison of the biomechanical effects of posterior and anterior spine stabilizing implants. Eur Spine J 14(5):445–453PubMedCrossRefGoogle Scholar
  20. 20.
    Baroud G, Bohner M (2006) Biomechanical impact of vertebroplasty: postoperative biomechanics of vertebroplasty. Joint Bone Spine 73:144–150PubMedCrossRefGoogle Scholar
  21. 21.
    Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into disc increases the risk of new fracture of adjacent vertebral body. AJNR 25:175–180PubMedGoogle Scholar
  22. 22.
    Laredo JD, Hamze B (2005) Complications of percutanous vertebroplasty and their prevention. Semin Ulrasound CT NRI 26:65–80CrossRefGoogle Scholar
  23. 23.
    Tanigawa N, Komemushi A, Kariya S, Kojima H, Shomura Y (2006) Radiological follow-up of new compression fractures following percutaneous vertebroplasty. CardioVasc Interv Radiol 29:92–96CrossRefGoogle Scholar
  24. 24.
    Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Janssens X, Verhaar HJ (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR 28:555–560PubMedGoogle Scholar
  25. 25.
    Lunt M, O’Neill T, Felsenberg D, Reeve J, Kanis J, Cooper C, Silman A (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Study (EPOS). Bone 33:505–513PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Johannes Hierholzer
    • 1
    Email author
  • Heiko Fuchs
    • 1
  • Kerstin Westphalen
    • 1
  • Clemens Baumann
    • 1
  • Christine Slotosch
    • 1
  • Rudolf Schulz
    • 2
  1. 1.Diagnostic and Interventional RadiologyKlinikum Ernst von Bergmann gGmbH, Academic Teaching Hospital, Charité, University Medicine BerlinPotsdamGermany
  2. 2.Musculoskeletal SurgeryKlinikum Ernst von BergmannPotsdamGermany

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