Clinical Analysis of Subsequent Non-operative Vertebral Compressible Fracture after Percutaneous Vertebroplasty_West China Medical Journal

Authors：

 XUDe-xing , CHENChang-li ,  CHENShuo

Department of Orthopedics, Dujiangyan Medical Ceter, Dujiangyan, Sichuan 611830, P. R. China;

Corresponding author：

CHENShuo, Email: 11411425@qq.com

Keywords：

Osteoporosis; Vertebral compressible fracture; Refracture; Vertebroplasty

DOI：

10.7507/1002-0179.20150351

Video：

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Objective To explore the therapeutic effects and clinical characteristics of repeated percutaneous vertebroplasty (PVP) on subsequent non-operative osteoporotic vertebral compressible fractures (OVCF) after initial PVP for OVCF. Methods From January 2008 to May 2013, 277 patients (331 vertebral bodies) with OVCF who were regularly followed up had underwent PVP. Among the 277 patients, the second treatment group included 42 patients who developed subsequent OVCF, which were retreated by PVP. And they were divided into adjacent new OVCF group (group A, 19 patients) and non-adjacent new OVCF group (group B, 23 patients). Analgesic effects and functional improvements were compared between the initial and second treatment. The interval of new OVCF after initial surgery, complications, and other clinical characteristics including age, gender, history of trauma, the amount of injected polymethylmethacrylate (PMMA) and PMMA leakage were compared between group A and B. Results The improvement rates of visual analogue scale scores were (64.6±12.6)% in the initial treatment group and (67.4±12.8)% in the second treatment group (P>0.05). The improvement rates of Oswestry Disability Index (ODI) were (60.6±13.3)% in the initial treatment group and (62.6±12.9)% in the second treatment group (P>0.05). The interval of incidence of subsequent new OVCF after the initial treatment were (62.4±45.5) days in group A and (203.7±77.6) days in group B, respectively (P<0.05). There were no significant differences in age, gender, history of trauma, the amount of injected PMMA and PMMA leakage between group A and group B (P>0.05). No surgery-related complications occurred after the second treatment except asymptomatic cement leakage in 5 patients, one of whom suffered from adjacent OVCF 3 months after the operation. Conclusion The therapeutic effect of repeated PVP for new OVCF on alleviating the pain and improving the function is just as the effect of the initial operation. Adjacent new OVCF primarily occurs earlier after initial PVP.

Citation： XUDe-xing, CHENChang-li, CHENShuo. Clinical Analysis of Subsequent Non-operative Vertebral Compressible Fracture after Percutaneous Vertebroplasty. West China Medical Journal, 2015, 30(7): 1217-1221. doi: 10.7507/1002-0179.20150351 Copy

1.	Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty[J]. Osteoporos Int, 2001, 12(6):429-437.
2.	Hargunani R, Le Corroller T, Khashoggi K, et al. An overview of vertebroplasty:current status, controversies, and future directions[J]. Can Assoc Radiol J, 2012, 63(3 Suppl):S11-S17.
3.	Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J]. Radiology, 2003, 226(1):119-124.
4.	Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty:adjacent fractures occur significantly sooner[J]. AJNR Am J Neuroradiol, 2006, 27(1):217-223.
5.	Lin EP, Ekholm S, Hiwatashi A, et al. Vertebroplasty:cement leakage into the disc increases the risk of new fracture of adjacent vertebral body[J]. AJNR Am J Neuroradiol, 2004, 25(2):175-180.
6.	Grados F, Depriester C, Cayrolle G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty[J]. Rheumatology (Oxford), 2000, 39(12):1410-1414.
7.	Tseng YY, Yang TC, Tu PH, et al. Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty[J]. Spine (Phila Pa 1976), 2009, 34(18):1917-1922.
8.	Revill SI, Robinson JO, Rosen M, et al. The reliability of a linear analogue for evaluating pain[J]. Anaesthesia, 1976, 31(9):1191-1198.
9.	Fairbank JC, Pynsent PB. The oswestry disability index[J]. Spine (Phila Pa 1976), 2000, 25(22):2940-2953.
10.	Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty[J]. Neurochirurgie, 1987, 33(2):166-168.
11.	Yen CH, Teng MM, Yuan WH, et al. Preventive vertebroplasty for adjacent vertebral bodies:a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty[J]. AJNR Am J Neuroradiol, 2012, 33(5):826-832.
12.	Rho YJ, Choe WJ, Chun YI. Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty[J]. Eur Spine J, 2012, 21(5):905-911.
13.	Hiwatashi A, Westesson PL. Patients with osteoporosis on steroid medication tend to sustain subsequent fractures[J]. AJNR Am J Neuroradiol, 2007, 28(6):1055-1057.
14.	Ma X, Xing D, Ma J, et al. Risk factors for new vertebral compression fractures after percutaneous vertebroplasty:qualitative evidence synthesized from a systematic review[J]. Spine (Phila Pa 1976), 2013, 38(12):E713-E722.
15.	张林, 卢春燕, 陈德才, 等. 经皮穿刺椎体成形术治疗老年性骨质疏松性椎体压缩骨折的临床应用[J]. 华西医学, 2010, 25(6):1052-1054.
16.	Zhang Z, Fan J, Ding Q, et al. Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty:a systematic review and meta-analysis[J]. J Spinal Disord Tech, 2013, 26(4):E150-E157.
17.	Zou J, Mei X, Zhu X, et al. The long-term incidence of subsequent vertebral body fracture after vertebral augmentation therapy:a systemic review and meta-analysis[J]. Pain Physician, 2012, 15(4):E515-E522.
18.	Li YA, Lin CL, Chang MC, et al. Subsequent vertebral fracture after vertebroplasty:incidence and analysis of risk factors[J]. Spine (Phila Pa 1976), 2012, 37(3):179-183.
19.	Ahn Y, Lee JH, Lee HY, et al. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty[J]. J Neurosurg Spine, 2008, 9(2):129-136.
20.	Chen WJ, Kao YH, Yang SC, et al. Impact of cement leakage into disks on the development of adjacent vertebral compression fractures[J]. J Spinal Disord Tech, 2010, 23(1):35-39.
21.	Garfin SR, Yuan HA, Reiley MA. New technologies in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J]. Spine (Phila Pa 1976), 2001, 26(14):1511-1515.
22.	Han S, Wan S, Ning L, et al. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture:a meta-analysis of randomised and nonrandomised controlled trials[J]. Int Orthop, 2011, 35(9):1349-1358.
23.	Papanastassiou ID, Phillips FM, Van Meirhaeghe J, et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies[J]. Eur Spine J, 2012, 21(9):1826-1843.
24.	Ma XL, Xing D, Ma JX, et al. Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture:grading the evidence through a systematic review and meta-analysis[J]. Eur Spine J, 2012, 21(9):1844-1859.
25.	曾凡伟, 王晓林, 王进, 等. 经皮穿刺椎体成形术治疗老年性骨质疏松性椎体压缩骨折的临床应用[J]. 华西医学, 2010, 25(6):1055-1058.
26.	Kim SH, Kang HS, Choi JA, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J]. Acta Radiol, 2004, 45(4):440-445.
27.	Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale[J]. Phys Ther, 2001, 81(2):776-788.
28.	Yu Y, Liu W, Song D, et al. Diagnosis of discogenic low back pain in patients with probable symptoms but negative discography[J]. Arch Orthop Trauma Surg, 2012, 132(5):627-632.

1. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty[J]. Osteoporos Int, 2001, 12(6):429-437.
2. Hargunani R, Le Corroller T, Khashoggi K, et al. An overview of vertebroplasty:current status, controversies, and future directions[J]. Can Assoc Radiol J, 2012, 63(3 Suppl):S11-S17.
3. Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis[J]. Radiology, 2003, 226(1):119-124.
4. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty:adjacent fractures occur significantly sooner[J]. AJNR Am J Neuroradiol, 2006, 27(1):217-223.
5. Lin EP, Ekholm S, Hiwatashi A, et al. Vertebroplasty:cement leakage into the disc increases the risk of new fracture of adjacent vertebral body[J]. AJNR Am J Neuroradiol, 2004, 25(2):175-180.
6. Grados F, Depriester C, Cayrolle G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty[J]. Rheumatology (Oxford), 2000, 39(12):1410-1414.
7. Tseng YY, Yang TC, Tu PH, et al. Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty[J]. Spine (Phila Pa 1976), 2009, 34(18):1917-1922.
8. Revill SI, Robinson JO, Rosen M, et al. The reliability of a linear analogue for evaluating pain[J]. Anaesthesia, 1976, 31(9):1191-1198.
9. Fairbank JC, Pynsent PB. The oswestry disability index[J]. Spine (Phila Pa 1976), 2000, 25(22):2940-2953.
10. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty[J]. Neurochirurgie, 1987, 33(2):166-168.
11. Yen CH, Teng MM, Yuan WH, et al. Preventive vertebroplasty for adjacent vertebral bodies:a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty[J]. AJNR Am J Neuroradiol, 2012, 33(5):826-832.
12. Rho YJ, Choe WJ, Chun YI. Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty[J]. Eur Spine J, 2012, 21(5):905-911.
13. Hiwatashi A, Westesson PL. Patients with osteoporosis on steroid medication tend to sustain subsequent fractures[J]. AJNR Am J Neuroradiol, 2007, 28(6):1055-1057.
14. Ma X, Xing D, Ma J, et al. Risk factors for new vertebral compression fractures after percutaneous vertebroplasty:qualitative evidence synthesized from a systematic review[J]. Spine (Phila Pa 1976), 2013, 38(12):E713-E722.
15. 张林, 卢春燕, 陈德才, 等. 经皮穿刺椎体成形术治疗老年性骨质疏松性椎体压缩骨折的临床应用[J]. 华西医学, 2010, 25(6):1052-1054.
16. Zhang Z, Fan J, Ding Q, et al. Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty:a systematic review and meta-analysis[J]. J Spinal Disord Tech, 2013, 26(4):E150-E157.
17. Zou J, Mei X, Zhu X, et al. The long-term incidence of subsequent vertebral body fracture after vertebral augmentation therapy:a systemic review and meta-analysis[J]. Pain Physician, 2012, 15(4):E515-E522.
18. Li YA, Lin CL, Chang MC, et al. Subsequent vertebral fracture after vertebroplasty:incidence and analysis of risk factors[J]. Spine (Phila Pa 1976), 2012, 37(3):179-183.
19. Ahn Y, Lee JH, Lee HY, et al. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty[J]. J Neurosurg Spine, 2008, 9(2):129-136.
20. Chen WJ, Kao YH, Yang SC, et al. Impact of cement leakage into disks on the development of adjacent vertebral compression fractures[J]. J Spinal Disord Tech, 2010, 23(1):35-39.
21. Garfin SR, Yuan HA, Reiley MA. New technologies in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J]. Spine (Phila Pa 1976), 2001, 26(14):1511-1515.
22. Han S, Wan S, Ning L, et al. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture:a meta-analysis of randomised and nonrandomised controlled trials[J]. Int Orthop, 2011, 35(9):1349-1358.
23. Papanastassiou ID, Phillips FM, Van Meirhaeghe J, et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies[J]. Eur Spine J, 2012, 21(9):1826-1843.
24. Ma XL, Xing D, Ma JX, et al. Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture:grading the evidence through a systematic review and meta-analysis[J]. Eur Spine J, 2012, 21(9):1844-1859.
25. 曾凡伟, 王晓林, 王进, 等. 经皮穿刺椎体成形术治疗老年性骨质疏松性椎体压缩骨折的临床应用[J]. 华西医学, 2010, 25(6):1055-1058.
26. Kim SH, Kang HS, Choi JA, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J]. Acta Radiol, 2004, 45(4):440-445.
27. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale[J]. Phys Ther, 2001, 81(2):776-788.
28. Yu Y, Liu W, Song D, et al. Diagnosis of discogenic low back pain in patients with probable symptoms but negative discography[J]. Arch Orthop Trauma Surg, 2012, 132(5):627-632.

West China Medical Journal

Clinical Analysis of Subsequent Non-operative Vertebral Compressible Fracture after Percutaneous Vertebroplasty

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