The therapeutic benefit of repeat percutaneous vertebroplasty at previously treated vertebral levels

Abstract

Background and purpose: Recurrent pain after vertebroplasty is relatively common, usually representing a new fracture at a different vertebral level. In a small cohort described herein, clinical and imaging findings indicated that recurrent pain arose from abnormality of the previously treated level. Our purpose was to demonstrate that repeat percutaneous vertebroplasty performed within the same fractured vertebra can offer therapeutic benefit for patients with recurrent pain after initial treatment.

Methods: We conducted a retrospective review of consecutive vertebroplasty procedures performed at our institution to define a patient population that underwent repeat vertebroplasty for recurrent pain at previously treated vertebral levels. We identified six such patients over an 8-year period, and clinical outcomes were assessed through quantitative measurements of pre- and postoperative levels of pain and mobility.

Results: Initial vertebroplasty resulted in substantial improvement in pain in all six patients. Patients developed recurrent pain between 8 days and 167 days after initial vertebroplasty. After repeat vertebroplasty, five of the six patients reported a reduction of at least 3 points in their rating of pain, with a mean reduction of 6.5 points and a mean postoperative pain level of 3.5 points (11-point scale). Four of six patients reported impaired mobility before repeat vertebroplasty, and all four demonstrated a postoperative improvement in mobility. Mean increase in mobility was 1.50 points, and the mean postoperative mobility impairment was 0.25 points (5-point scale).

Conclusion: The clinical outcomes of the patients within this case series suggest that repeat percutaneous vertebroplasty performed at previously treated vertebral levels for recurrent pain offer therapeutic benefit.

Fig 1.

76-year-old man with L1 vertebral body fracture. A, Lateral conventional radiograph after initial vertebroplasty. After administration of 3 mL of cement via a left unilateral transpediculate approach, the cement opacifies the anterior portion of the vertebral body (arrow). The patient reported complete pain relief after the procedure. B, Lateral conventional radiograph after repeat vertebroplasty. After administration of an additional 1.2 mL of cement via a right unilateral transpediculate approach, the filling pattern has changed from A to include prominent posterior opacification. The patient reported moderate pain relief after the procedure.