Percutaneous Vertebroplasty - New Vertebral Fractures

New Vertebral Fractures

According to Hu and Hart, new adjacent level vertebral compression fractures typically occur when cement leaks into the disc space above and/or below the target vertebral body. In a study regarding this topic, Lin et al. observed that 58% of vertebral bodies adjacent to a disc space with cement leakage experienced successive fractures compared to occurrence of new fractures in 12% of vertebral bodies adjacent to a disc space without cement leakage. In this study, it was hypothesized that the new vertebral fractures resulted from a combination of factors. The patient’s underlying spinal disease (e.g., osteoporosis or vertebral metastasis) in conjunction with the alteration in the biomechanics of force transmission through the augmented vertebral body were suspected of increasing the risk of subsequent vertebral fractures post-vertebroplasty. In addition, Lin et al. believe that there was increased stress placed on the adjacent vertebral body after vertebroplasty that may have contributed to new fractures, stating that pain reduction and subsequent increased activity by the patient were the contributing factors. Hu and Hart state that multiple retrospective reviews have shown an increased risk of adjacent vertebral body fractures after vertebroplasty and mention a study by Trout et al. in which 41.4% of 186 new fractures were adjacent to the treated level in 86 of 432 patients with new fractures. In Trout’s study, it was found that the relative risk of adjacent level was 4.62 times greater than that for nonadjacent level fractures however they could not prove that vertebroplasty was the cause of these adjacent vertebral fractures, stating that they could only suggest a strong association between the two events.

By contrast, a smaller study by Frankel et al. found that no new adjacent level fractures were observed within a 3 month period in a sample of 19 patients that had 26 fractures treated via vertebroplasty. In this study, the nineteen patients underwent vertebroplasty using a novel cannulated, fenestrated bone tap that resulted in no radiculopathy from cement extravasation and asymptomatic cement extravasation in only 7.7% of the patients (2 out of 26 treated vertebral fractures).