Magnetic Resonance Enhancement Pattern as a Predictor of Cement Volume in Vertebroplasty Procedures for Osteoporotic Fractures

PURPOSE: To identify the differences between injected cement volumes during vertebroplasty procedures according to the enhancement pattern of pre-procedure magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: Thirty-two patients who underwent 52 vertebroplasty procedures as well as pre-procedure contrast-enhanced spine MRI in the authors' institution were reviewed retrospectively. The 52 procedures were divided into two groups according to different enhancement patterns shown by pre-procedure MR imaging [E(+) and E(−)]. The volumes of the enhancing/non-enhancing portions of the fractured vertebral body shown by pre-procedural MR imaging were calculated and compared to the volumes of the injected cement during the vertebroplasty procedures. RESULTS: The 52 injections included 28 (56%) in Group E(+) and 24 (44%) in Group E(−). The actual volume ratio of the injected cement to the volume of the non-enhanced or enhanced region calculated based on the contrast-enhanced MRI was 0.22 ± 0.11 (cc/cm³) in the E(+) group and 0.93 ± 0.62 (cc/cm³) in the E(−) group. The average amount of injected cement was significantly different between Group E(+) and Group E(−) (P < 0.001). In addition, the ratio of the injected cement amount to the volume of the enhanced or non-enhanced portion based on the contrast-enhanced MRI in Group E(−) was significantly higher than that of Group E(+) (P < 0.001). CONCLUSION: Different enhancement patterns shown by pre-procedure MRI can predictors of the injected cement volume during vertebroplasty procedures for osteoporotic fractures.

Gradual Height Decrease of Augmented Vertebrae after Vertebroplasty at the Thoracolumbar Junction / 대한신경손상학회지

OBJECTIVE: Vertebroplasty is an effective treatment for vertebral compression fracture, but may progress gradual vertebral height decrease in spite of vertebroplasty. Gradual vertebral height decrease also may induce aggravation of kyphotic change without severe pain. The purpose of this study was to evaluate risk factors for gradual vertebral height decrease in the absence of recurrent severe back pain. METHODS: A retrospective analysis was performed on 44 patients who were diagnosed with a first osteoporotic compression fracture at a single level at the thoracolumbar junction. All patients were taken vertebroplasty. Possible risk factors for gradual vertebral height decrease, such as sex, age, bone mineral density, body mass index, level of compression fracture, volume of injected cement, cement leakage into disc space, and air clefts within fractured vertebrae, were analyzed. RESULTS: Gradual vertebral height decrease of augmented vertebrae occurred commonly when more than 4 cc of injected cement was used, and when air clefts within fractured vertebrae were seen on admission. In addition, the sagittal Cobb angle more commonly increased during the follow-up period in such cases. CONCLUSION: Injection of more than 4 cc of cement during vertebroplasty and air cleft within fractured vertebrae on admission induced gradual vertebral height decrease in augmented vertebrae. Thus, longer follow-up will be needed in such cases, even when patients do not complain of recurrent severe back pain.

Risk Factors for Subsequent Fracture after Osteoporotic Vertebral Compression Fracture / 대한신경손상학회지

OBJECTIVE: Percutaneous vertebroplasty is an effective treatment that relieves pain caused by vertebral compression fracture. However, vertebroplasty may increase the risk for subsequent vertebral compression fracture. The purpose of this study is to evaluate the incidence of and risk factors for subsequent fracture after vertebroplasty. METHODS: A retrospective analysis was performed for 112 patients who were diagnosed with a first osteoporotic compression fracture at a single level and underwent vertebroplasty at that level. Possible risk factors for subsequent fracture, such as age, sex, bone mineral density (BMD), location of treated vertebrae, pattern of cement distribution, cement volume, presence of intradiscal cement leakage, and direction of cement leakage, were analyzed. RESULTS: During the follow-up period, 18 new subsequent vertebral fractures developed (16.1%). Subsequent fractures were more common in osteoporotic patients (T-score or =3.5 cc were also associated with a significantly higher risk of fracture (p=0.012, r=0.238). CONCLUSION: Low BMD and volume of intravertebral cement were the factors most strongly associated with subsequent fracture after percutaneous vertebroplasty.

Risk Factors for Subsequent Fracture after Osteoporotic Vertebral Compression Fracture / 대한신경손상학회지

OBJECTIVE: Percutaneous vertebroplasty is an effective treatment that relieves pain caused by vertebral compression fracture. However, vertebroplasty may increase the risk for subsequent vertebral compression fracture. The purpose of this study is to evaluate the incidence of and risk factors for subsequent fracture after vertebroplasty. METHODS: A retrospective analysis was performed for 112 patients who were diagnosed with a first osteoporotic compression fracture at a single level and underwent vertebroplasty at that level. Possible risk factors for subsequent fracture, such as age, sex, bone mineral density (BMD), location of treated vertebrae, pattern of cement distribution, cement volume, presence of intradiscal cement leakage, and direction of cement leakage, were analyzed. RESULTS: During the follow-up period, 18 new subsequent vertebral fractures developed (16.1%). Subsequent fractures were more common in osteoporotic patients (T-score or =3.5 cc were also associated with a significantly higher risk of fracture (p=0.012, r=0.238). CONCLUSION: Low BMD and volume of intravertebral cement were the factors most strongly associated with subsequent fracture after percutaneous vertebroplasty.