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Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture?

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Abstract

Objective

The purpose of this study was to evaluate the incidence and risk factors associated with adjacent vertebral fracture after percutaneous vertebroplasty (PVP) to treat osteoporotic vertebral compression fractures. We also investigated the effect of intradiscal cement leakage on adjacent vertebral fracture formation after PVP.

Materials and methods

From January 2003 to March 2009, 188 patients (163 women, 25 men; mean age, 70.9 years; range, 42–92 years) who underwent 214 PVP sessions at 351 levels for osteoporotic vertebral compression fractures were retrospectively enrolled in this study. The effect of intradiscal cement leakage on new adjacent vertebral fracture formation after PVP was evaluated. Possible other risk factors were also analyzed using univariate and multivariate methods. The risk factors included age, gender, mean bone mineral density (BMD), the vertebral level treated, presence of an intravertebral cleft or cyst before treatment, kyphosis angle, wedge angle, and the injected cement volumes.

Results

During the follow-up periods, new adjacent vertebral fractures developed in 36 (10.3%) of 351 treated levels. For 91 (25.9%) levels, intradiscal cement leakage was detected on procedural fluoroscopic radiographs. There was no statistically significant association between intradiscal cement leakage and new adjacent vertebral compression fracture (p = 0.789). Among the other risk factors, only the vertebral levels treated, especially the thoracolumbar junction, showed a significant relationship to new adjacent vertebral fractures (univariate analysis, p = 0.037; multivariate analysis, p = 0.043).

Conclusions

Intradiscal cement leakage does not seem to be related to subsequent adjacent vertebral compression fracture in patients who underwent PVP for treatment of an osteoporotic compression fracture. The thoracolumbar location of the initial compression fracture is the only factor correlated with an adjacent vertebral fracture after PVP.

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References

  1. Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol. 2004;45(4):440–5.

    Article  CAS  PubMed  Google Scholar 

  2. Dublin AB, Hartman J, Latchaw RE, Hald JK, Reid MH. The vertebral body fracture in osteoporosis: restoration of height using percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2005;26(3):489–92.

    PubMed  PubMed Central  Google Scholar 

  3. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol. 2006;27(1):217–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Lee WS, Sung KH, Jeong HT, Sung YS, Hyun YI, Choi JY, et al. Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J. 2006;15(12):1777–83.

    Article  PubMed  Google Scholar 

  5. Berlemann U, Ferguson SJ, Nolte LP, Heini PF. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br. 2002;84(5):748–52.

    Article  CAS  PubMed  Google Scholar 

  6. Ahn Y, Lee JH, Lee HY, Lee SH, Keem SH. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine. 2008;9(2):129–36.

    Article  PubMed  Google Scholar 

  7. Lin WC, Cheng TT, Lee YC, Wang TN, Cheng YF, Lui CC, et al. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol. 2008;19(2 Pt 1):225–31.

    Article  PubMed  Google Scholar 

  8. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003;226(1):119–24.

    Article  PubMed  Google Scholar 

  9. Hiwatashi A, Ohgiya Y, Kakimoto N, Westesson PL. Cement leakage during vertebroplasty can be predicted on preoperative MRI. AJR Am J Roentgenol. 2007;188(4):1089–93.

    Article  PubMed  Google Scholar 

  10. Bartynski WS, Heller MT, Grahovac SZ, Rothfus WE, Kurs-Lasky M. Severe thoracic kyphosis in the older patient in the absence of vertebral fracture: association of extreme curve with age. AJNR Am J Neuroradiol. 2005;26(8):2077–85.

    PubMed  PubMed Central  Google Scholar 

  11. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004;25(2):175–80.

    PubMed  PubMed Central  Google Scholar 

  12. Teng MM, Wei CJ, Wei LC, Luo CB, Lirng JF, Chang FC, et al. Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2003;24(9):1893–900.

    PubMed  PubMed Central  Google Scholar 

  13. Mirovsky Y, Anekstein Y, Shalmon E, Blankstein A, Peer A. Intradiscal cement leak following percutaneous vertebroplasty. Spine. 2006; 31(10):1120–1124.

    Article  PubMed  Google Scholar 

  14. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M. Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J. 2005;14(5):466–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine. 2001; 26(14):1511–1515.

    Article  CAS  PubMed  Google Scholar 

  16. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int. 2001;12(6):429–37.

    Article  CAS  PubMed  Google Scholar 

  17. Shapiro S, Abel T, Purvines S. Surgical removal of epidural and intradural polymethylmethacrylate extravasation complicating percutaneous vertebroplasty for an osteoporotic lumbar compression fracture. Case report. J Neurosurg. 2003;98(1 Suppl):90–2.

    PubMed  Google Scholar 

  18. Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A. Intradiskal extravasation with low-volume cement filling in percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2005;26(9):2397–401.

    PubMed  PubMed Central  Google Scholar 

  19. Pitton MB, Herber S, Bletz C, Drees P, Morgen N, Koch U, et al. CT-guided vertebroplasty in osteoprotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up. Eur Radiol. 2008;18(1):43–50.

    Article  CAS  PubMed  Google Scholar 

  20. Peh W, Gillula L, Peck D. Percutaneous vertebroplasty for severe osteoporotic vertebral compression fractures. Radiology. 2002;223:121–6.

    Article  PubMed  Google Scholar 

  21. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919–23.

    Article  CAS  PubMed  Google Scholar 

  22. Arden NK, Griffiths GO, Hart DJ, Doyle DV, Spector TD. The association between osteoarthritis and osteoporotic fracture: the Chingford Study. Br J Rheumatol. 1996;35(12):1299–304.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was conducted with the Korea University Research Grant.

All authors have no financial relationships with commercial entities.

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Authors and Affiliations

  1. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 97, Gurodong-Gil, Guro-Gu, Seoul, 152–703, Korea

    Kyung-Ah Lee, Suk-Joo Hong, In Ho Cha & Eun-Young Kang

  2. Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea

    Seunghun Lee

  3. Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea

    Baek-Hyun Kim

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  1. Kyung-Ah Lee
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  2. Suk-Joo Hong
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  3. Seunghun Lee
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  4. In Ho Cha
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Correspondence to Suk-Joo Hong.

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Lee, KA., Hong, SJ., Lee, S. et al. Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture?. Skeletal Radiol 40, 1537–1542 (2011). https://doi.org/10.1007/s00256-011-1139-x

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  • DOI: https://doi.org/10.1007/s00256-011-1139-x

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