European Spine Journal

, Volume 21, Issue 5, pp 905–911

Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty

Original Article

Abstract

Introduction

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures to alleviate pain caused by osteoporotic vertebral compression fractures (VCFs). New vertebral compression fracture (NVCF) has been noted as a potential late sequela of the procedures. The incidence of NVCFs and affecting risk factors were investigated.

Materials and methods

The authors retrospectively analyzed the occurrence of NVCFs in 147 patients treated with PVP or PKP for osteoporotic VCFs. Possible risk factors, such as age, gender, body mass index, bone mineral density (BMD), location of treated vertebra, treatment modality, amount of bone cement injected, anterior–posterior ratio of the fractured vertebra, cement leakage into the disc space, and pattern of cement distribution, were assessed.

Results

Twenty-seven patients (18.4%) had subsequent symptomatic NVCFs with a median time to new fracture was of 70 days. The 1-year symptomatic fracture-free rate was 85.0% by the Kaplan–Meier estimate. Eighteen (66.7%) of the 27 patients had an NVCF on the adjacent vertebra. Significant differences (P < 0.05) were found between the NVCF and control groups in regard to age, treatment modality, BMD, and the proportion of cement leakage into the disc space. Discal cement leakage and low BMD affected on adjacent NVCFs.

Conclusion

The most important risk factors affecting NVCFs were osteoporosis and intervertebral discal cement leakage.

Keywords

Osteoporotic compression fracture Vertebroplasty Kyphoplasty BMD Discal leakage 

References

  1. 1.
    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
  2. 2.
    Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84:748–752PubMedCrossRefGoogle Scholar
  3. 3.
    Cohen JE, Lylyk P, Ceratto R, Kaplan L, Umanskyt F, Gomori JM (2004) Percutaneous vertebroplasty: technique and results in 192 procedures. Neurol Res 26:41–49PubMedCrossRefGoogle Scholar
  4. 4.
    Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K et al (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98:21–30PubMedCrossRefGoogle Scholar
  5. 5.
    Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168PubMedGoogle Scholar
  6. 6.
    Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414CrossRefGoogle Scholar
  7. 7.
    Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45:440–445PubMedCrossRefGoogle Scholar
  8. 8.
    Klotzbuecher CM, Ross PD, Landsmen PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  9. 9.
    Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S et al (2006) Percutaneous vertebroplasty for osteoporotic compression fractures: multivariate study of predictors of new vertebral body fracture. Cardiovasc intervent Radiol 29:580–585PubMedCrossRefGoogle Scholar
  10. 10.
    Legroux-Gérot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B (2004) Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol 23:310–317PubMedCrossRefGoogle Scholar
  11. 11.
    Lee WS, Sung KH, Jeong HT, Sung YS, Hyun YI, Choi JY et al (2006) Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J 15:1777–1783PubMedCrossRefGoogle Scholar
  12. 12.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fractures in the year following a fracture. JAMA 285:320–323PubMedCrossRefGoogle Scholar
  13. 13.
    Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR 25:175–180PubMedGoogle Scholar
  14. 14.
    Lin WC, Cheng TT, Lee YC, Wang TN, Cheng YF, Lui CC et al (2008) New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol 19:225–232PubMedCrossRefGoogle Scholar
  15. 15.
    Moon ES, Kim HS, Park JO, Moon SH, Lee HM, Shin DE et al (2007) The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved. Yonsei Medical J 48:645–652CrossRefGoogle Scholar
  16. 16.
    Nakano M, Hirano N, Ishihara H, Kawaguchi Y, Matsuura K (2005) Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: risk factor analysis for cement leakage. J Neurosurg Spine 2:27–33PubMedCrossRefGoogle Scholar
  17. 17.
    Nevitt MC, Thompson DE, Black DM, Rubin SR, Ensrud K, Yates AJ (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 160:77–85PubMedCrossRefGoogle Scholar
  18. 18.
    Ooms ME, Lips P, Van Lingen A, Valkenburg HA (1993) Determinants of bone mineral density and risk factors for osteoporosis in healthy elderly women. J Bone Miner Res 8:669–675PubMedCrossRefGoogle Scholar
  19. 19.
    Peh WC, Gilula LA, Peck DD (2002) Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 223:121–126PubMedCrossRefGoogle Scholar
  20. 20.
    Ryu KS, Park CK, Kim MC, Kang JK (2002) Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 96:56–61PubMedGoogle Scholar
  21. 21.
    Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A (2005) New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR 26:1601–1604PubMedGoogle Scholar
  22. 22.
    Tanigawa N, Komemushi A, Kariya S, Kojima H, Shomura Y, Naoto O et al (2007) Relationship between cement distribution pattern and new compression fracture after percutaneous vertebroplasty. AJR 189:W348–W352PubMedCrossRefGoogle Scholar
  23. 23.
    Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR 27:217–223PubMedGoogle Scholar
  24. 24.
    Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124PubMedCrossRefGoogle Scholar
  25. 25.
    Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17:71–76PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of NeurosurgeryKonkuk University School of MedicineSeoulKorea

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