Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body

Abstract

Background and purpose: Patients successfully treated with vertebroplasty often return with new pain caused by a new vertebral body fracture. The new fractures often are adjacent to the vertebral bodies that were initially treated. In our clinical work, we have observed that cement leakage into the disk increases the risk of new fracture of the adjacent vertebral body. This study analyzed the risk of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk.

Methods: This study was based on 38 patients with painful compression fractures treated with vertebroplasty. Patients who returned with new pain after initial successful vertebroplasty were evaluated by repeat MR imaging. We analyzed the incidence of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk that had occurred during the initial vertebroplasty.

Results: Fourteen patients developed new fractures during the follow-up period. In 10 patients, the new fractures were associated with cement leakage into the disk, whereas four patients had new fractures that were not associated with cement leakage into the disk. This difference was statistically significant (P =.018). A detailed analysis showed that 58% of vertebral bodies adjacent to a disk with cement leakage fractured during the follow-up period compared with 12% of vertebral bodies adjacent to a disk without cement leakage (P <.0005).

Conclusion: Leakage of cement into the disk during vertebroplasty increases the risk of a new fracture of adjacent vertebral bodies.

Fig 1.

Images of an 85-year-old woman with back pain. A, Pre-vertebroplasty sagittal view T1-weighted MR image shows bone marrow edema of T12. B, Pre-vertebroplasty sagittal view T2-weighted MR image shows bone marrow edema of T12. C, Sagittal view contrast-enhanced T1-weighted MR image shows enhancement, indicating an acute T12 compression fracture. D, Post-vertebroplasty sagittal view reformatted CT scan shows cement leakage into the T11–T12 disk.

Fig. 1.

Continued E, Sagittal view T1-weighted MR image obtained 15 days later, when the patient returned with new pain, shows new bone marrow edema of T11. F, Sagittal view T2-weighted MR image obtained 15 days later, when the patient returned with new pain, shows new bone marrow edema of T11. G, Contrast-enhanced sagittal view T1-weighted MR image shows T11 enhancement, indicating a new acute T11 fracture.

Fig 2.

Images of a 79-year-old man with back pain. A, Pre-vertebroplasty sagittal view T1-weighted MR image shows bone marrow edema of T12 and L1. B, Pre-vertebroplasty sagittal view T2-weighted MR image shows bone marrow edema of T12 and L1. C, Sagittal view contrast-enhanced T1-weighted MR image shows enhancement, indicating acute T12 and L1 compression fractures. D, Post-vertebroplasty sagittal view reformatted CT scan shows cement leakage (arrow) into the L1–L2 disk. Of note, leakage of cement into the T11–T12 disk also occurred. However, T11 was treated with vertebroplasty at the same time as T12 and T11 therefore could not be evaluated for a possible new fracture.

Fig 2.

Continued E, Sagittal view T1-weighted MR image obtained 25 days later, when the patient returned with new pain, shows a focal area of new bone marrow edema of L2 (arrows). F, Sagittal view T2-weighted MR image obtained 25 days later, when the patient returned with new pain, shows a focal area of new bone marrow edema of L2 (arrows). G, Contrast-enhanced sagittal view T1-weighted MR image shows enhancement, indicating a new acute focal fracture of L2 superiorly. The new fracture (arrows) is located immediately adjacent to the cement leakage into the disk.