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Predictive Factors for Subsequent Vertebral Fracture After Percutaneous Vertebroplasty.

While percutaneous vertebroplasty is an effective tool in the treatment of vertebral compression fracture, twelve to 52 percent will have post percutaneous vertebroplasty, PVP, vertebral fracture.

The authors of the study were hoping to gain knowledge about risk factors for the development of post PVP vertebral fracture. They reviewed medical records of 508 patients who underwent PVP. Those with fractures from trauma and malignancies were excluded. They selected cases that had to undergo additional vertebroplasty following PVP. These 45 cases were divided up into two groups. Those with adjacent level fracture, and those with nonadjacent fracture. OVer 71 percent, or 35 of the cases were in the adjacent level fracture group. Fourteen cases were in the non-adjacent fracture group. They also chose a control group of 50 cases where there was no evidence of subsequent vertebral fracture following PVP.

Percutaneous vertebroplasty was done under fluoroscopy using an 11-gauge bone biopsy needle placed in the anterior third of the vertebral body for all patients. The bone cement was injected into the vertebral body until it reached the posterior quarter of the vertebral body, or when significant leakage occurred.

The authors reviewed various factors in order to determine risk fracture for post PVP vertebral fracture. Demographic factors such as age, and sex were evaluated. Constitutional factors included mean body mass index, mean body weight, and mean bone mass density. Spinal geometry evaluated adjacent range of motion, and degree of local kyphosis. The authors also looked at the mean volume of cement used. Lastly, they evaluated the effect of needle placement, either unilateral or bilateral.

The authors concluded that from the parameters they studied, risk factors for subsequent adjacent fracture following PVP was different than those for nonadjacent fractures. Slenderly built patients with osteoporotic bone and lower BMI were more at risk for sustaining an adjacent level fracture after vertebroplasty. Heavier patients with osteoporotic bone ran the risk of sustaining a nonadjacent fracture. Mobility gradient between neighboring segments was determined to be a risk factor for nonadjacent fracture. Intradiscal leakage of cement, rather than volume used, was predictive of adjacent level fracture.


Y. Ahn et al. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine. August 2008. Volume 9. Number 2. Pp. 129-136.

08/28/2008

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