The Retrial of Percutaneous Vertebroplasty for the Treatment of Vertebral Compression Fracture

OBJECTIVE: For the treatment of osteoporotic vertebral compression fracture, percutaneous vertebroplasty (PVP) is currently widely used as an effective and relatively safe procedure. However, some patients do not experience pain relief after PVP. We performed several additional PVP procedures in those patients who did not have any improvement of pain after their initial PVP and we obtained good results. Our purpose is to demonstrate the effective results of an additional PVP procedure at the same previously treated level. METHODS: We reviewed the medical records and the radiologic data of the PVP procedures that were performed at our hospital from November 2005 to May 2008 to determine the patients who had undergone additional PVP. We identified ten patients and we measured the clinical outcomes according to the visual analogue scale (VAS) score and the radiologic parameters, including the anterior body height and the kyphotic angulation. RESULTS: The mean volume of polymethylmethacrylate injected into each vertebrae was 4.3 mL (range: 2-8 mL). The mean VAS score was reduced from 8 to 2.32. The anterior body height was increased from 1.7 cm to 2.32 cm. The kyphotic angulation was restored from 10.14 degrees to 2.32 degrees. There were no complications noted. CONCLUSION: The clinical and radiologic outcomes suggest that additional PVP is effective for relieving pain and restoring the vertebral body in patients who have unrelieved pain after their initial PVP. Our study demonstrates that additional PVP performed at the previously-treated vertebral levels could provide therapeutic benefit.

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

Analysis of Results Using Percutaneous Vertebroplasty for the Treatment of Avascular Necrosis of the Vertebral Body

OBJECTIVE: Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment's efficacy in this report. METHODS: Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain. RESULTS: The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted. CONCLUSION: PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.

Extreme Multi-Level Percutaneous Vertebroplasty for Newly Developed Multiple Adjacent Compression Fractures

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.