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Kim, Hwang, and Park: Adjacent Vertebral Compression Fracture after Percutaneous Vertebroplasty
Original Article

Journal of Korean Spine Surg 2013;20(4):163-168.

Published online: 21 December 2013

DOI: https://doi.org/10.4184/jkss.2013.20.4.163

Adjacent Vertebral Compression Fracture after Percutaneous Vertebroplasty

Chung-Hwan Kim, M.D., Jae-Kwang Hwang, M.D., Jun-Seok Park, M.D.

Department of Orthopedic Surgery, Ulsan University, Medical College, Gangneung Asan Hospital, Gangneung, Korea

Corresponding author: Jae-Kwang Hwang, M.D. Department of Orthopedic Surgery, Gangneung Asan Hospital, Ulsan University, 415 Bangdongri, Sachonmyeun, Gangneung, Korea TEL: 82-33-610-3242, FAX: 82-33-641-8050 E-mail: jkhwang@gnah.co.kr

Received 22 September 2013       Revised 26 September 2013       Accepted 9 December 2013

Copyright © 2013 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To find out the characteristics and the risk factors of adjacent vertebral compression fracture after percutaneous vertebroplasty.

Summary of Literature Review

Percutaneous vertebroplasty is regarded as more effective treatment than conservative care, but additional fracture could cause complications during follow up.

Materials and Methods

We analyzed 43 patients who had only one vertebral compression fracture after one vertebroplasty. The number of patients who had additional compression fracture within one level from the operated vertebra were 23 cases (Group I); beyond two levels from the operated vertebra were 20 cases (Group II). We compared the onset period of additional compression fracture, the degree of osteoporosis, age, level, restoration of vertebral body height and kyphosis between the two groups.

Results

The onset period of additional compression fracture was 18.7±28.1 months in Group I and 42.7±39.4 months in Group II, showing significant difference between the two groups. Group I had more cases of previous vertebroplasty on thoracolumbar vertebra than Group II. The restoration rate of vertebral body height of Group I was 42.3±40.9% and that of Group II was 22.8±21.6%, which shows significant difference between the two.

Conclusion

Adjacent vertebral compression fracture after vertebroplasty can occur earlier than non adjacent one. We need to pay attention to the patients who had higher restoration rate of vertebral body height after vertebroplsty as they are more prone to having additional adjacent compression fracture.

Keywords: Osteoporosis, Compression fracture, Percutaneous vertebroplasty, Adjacent vertebral fracture, Restoration rate of vertebral body height

REFERENCES

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Table 1.
Time of Another Vertebral Fracture Occurrence
Cases Adjacent vertebral fracture Non-adjacent vertebral fracture Total
Within 1 year 14 6 20
After 1 year 9 14 23
Total 23 20 43

Values are presented as number. p-value : 0.0429

Table 2.
Comparison between Adjacent and Non-adjacent Vertebral Fracture
Variable Adjacent vertebral fracture (n=23) Non-adjacent vertebral fracture (n=20) p-value
BMD -3.5±2.0 -3.1±1.5 0.2100
Preoperative vertebral-height compression rate (%) 38.0±15.0 35.3±17.6 0.5224
Postoperative vertebral-height restoration rate (%) 42.3±40.9 22.8±21.6 0.0470
Postoperative vertebral-angle difference (°) 5.1±3.3 4.6±3.0 0.5510
Values are presented as mean±standard deviation. BMD: Bone marrow density
Table 3.
Comparison between Another Vertebral Fracture within 1 year and after 1 year
Variable Another fracture within 1 year (n=20) Another fracture after 1 year (n=23) p–value
BMD -3.4±1.8 -3.2±1.7 0.5116
Preoperative vertebral-height compression rate(%) 33.4±13.8 39.6±14.1 0.1488
Postoperative vertebral-height restoration rate(%) 31.9±36.2 34.5±33.5 0.2460
Postoperative vertebral-angle difference (°) 5.5±3.0 4.3±3.3 0.2460

Values are presented as mean±standard deviation. BMD: Bone marrow density

Table 4.
Cement Leakage and Another Vertebral Fracture
Cases Cement leakage in followup CT scan Non-Cement leakage in followup CT scan Total
Adjacent vertebral fracture 7 16 23
Non-adjacent vertebral fracture 9 11 20
Total 16 27 43

Values are presented as number. p-value : 0.5711

Table 5.
Comparison between Thoracolumbar and Non-thoracolumbar Facture
Cases Primary thoracolumbar vertebral fracture Primary non-thoracolumbar vertebral fracture Total
Thoracolumbar vertebral fracture 21 6 27
Non-thoracolumbar vertebral fracture 7 9 16
Total 28 15 43

Values are presented as number. p-value : 0.024

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