Subsequent Vertebral Fracture after Percutaneous Vertebral Augmentation: Adjacent and Non-adjacent Vertebral Fractures

ABSTRACT

OBJECTIVE: To analyze the incidence and risk factors of subsequent vertebral fracture after percutaneous vertebral augme- ntation(PVA) in patients with osteoporotic compression fractures(OCF). METHODS: The authors reviewed 27 patients(20 women and 7 men, 39 vertebrae) who underwent vertebral augmentation for the treatment of osteoporotic compression fracture at a single institute between January 2000 and January 2009. The patients were divided into 2 groups Group I included patients without subsequent fracture and Group II included those with subsequent fracture. Subsequent fractures, including adjacent-level and nonadjacent-level vertebral fractures, were confirmed with radiographs or MRI. Factors such as smoking, diabetes mellitus(DM), previous bisphosphonate use, body mass index(BMI), bone mineral density(BMD), the amount of polymethylmethacrylate(PMMA), intradiscal leakage of PMMA and unilateral approach were analyzed statistically. RESULTS: Nine patients(33.3%, Group II) sustained 16 subsequent vertebral fractures(9 adjacent-level vertebral fractures and 7 nonadjacent-level vertebral fractures). Subsequent vertebral fractures at the lumbar level(81.3%) were more fre- quent than those at thoracic level(18.8%). BMI, BMD, smoking, DM, amount of PMMA, unilateral approach, and bis- phosphonate use did not correlate with the risk of subsequent fracture. Intradiscal leakage of PMMA was the only signifi- cant risk factor(P=0.027). CONCLUSIONS: The high rate of subsequent vertebral fracture should be considered before vertebral augmentation with PMMA. The intradiscal leakage of PMMA could increase the risk of subsequent fracture.