Percutaneous Vertebroplasty Does Not Increase the Incidence of New Fractures in Adjacent and Nonadjacent Vertebral Bodies

Abstract

Study design: This was a clinical retrospective study.

Objectives: This retrospective study aimed to investigate the incidence of new vertebral compression fractures (NVCFs) and analyze the risk factors that influence the secondary fractures in adjacent and nonadjacent levels after percutaneous vertebroplasty (PVP) and conservative treatment (CT).

Summary of background data: PVP is an effective procedure to alleviate the pain caused by osteoporotic vertebral compression fractures. NVCFs have been noted as a potential late sequela of the procedure. However, it remains unclear whether NVCFs are due to this augmentation or simply are the result of the natural progression of osteoporosis.

Methods: A total of 290 patients who had undergone PVP and 270 patients who had undergone CT during the last 4 years were examined. They were followed-up on a monthly basis by telephone for >2 years. They were divided into 2 groups: NVCFs and non-NVCFs. The groups were statistically compared in terms of age, sex, body mass index, initial fracture levels, bone mineral density (BMD) score of the spine, original fracture levels, and new fracture levels.

Results: After a mean follow-up of at least 24 months (range, 24-78 mo), 42 NVCFs occurred in 37 of 290 patients after PVP and 33 NVCFs in 30 of 270 patients after CT. Only BMD was significantly different between the groups. Lower BMD was a significant predictive factor for NVCFs.

Conclusions: PVP did not increase the incidence of NVCFs, especially those adjacent to the treated vertebrae, following augmentation with PVP compared with CT. The most important risk factor for NVCFs was osteoporosis.

FIGURE 1

A 64-year-old woman with severe osteoporosis (bone mineral density, T=5.8) presented with back pain. A and B, An acute fracture was observed in T11 (arrow). C and D, T11 vertebroplasty was performed. E and F, Only 2 weeks later, 2 new body fractures were found in T10 and T12 (arrows).

FIGURE 2

A 73-year-old woman with severe osteoporosis (bone mineral density, T=5.6) presented with back pain. L5 compression fracture was treated conservatively. A and B, Only 3 weeks later, 2 new body fractures were found in L4 and T12 (arrows).