Download PDF
CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2021; 5(01): 035-040
DOI: 10.1055/s-0041-1731603
Original Article

Vertebroplasty Increases the Incidence Of New Vertebral Compression Fractures Compared To Conservative Management

Maram Othman  
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Meshal Alshaalan  
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Abdulrahman Khawaji
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Rawan Benkuddah
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Hala Khalil
2   Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Khalid Alismail
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Waleed Althobaity
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
,
Saleh Alreshoodi
1   Medical Imaging Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
› Author Affiliations Funding No funding were received for the current study.
› Further Information
   Permissions and Reprints

Abstract

Background Vertebral osteoporotic fractures are a major cause of morbidity and disability among the elderly population.

This study sought to compare the incidence of new vertebral fractures in patients treated by vertebroplasty with that of those managed conservatively, while also assessing the potential risk factors contributing to the occurrence of these fractures.

Materials and Methods The details of a total of 121 eligible subjects with radiologically proven osteoporotic vertebral fractures were retrieved from our archive between January 2010 and September 2019 and divided, based on the treatment method, into percutaneous vertebroplasty (PVP) (n = 60) and nonsurgical treatment (n = 61). The included subjects’ clinical data, demographic profiles, and imaging findings on plain radiography, CT, and MRI scans performed at baseline and within 24 months following treatment were reviewed and documented.

Results The difference in the incidence of new fractures was statistically significant (p = 0.001), with rates of 70% (n = 32) in the vertebroplasty group and 30% (n = 14) in the conservatively treated cases reported at a median follow-up time point of approximately 4 months. The presence of liver disease (p = 0.037), a history of transplantation (p = 0.003), the use of steroids (p = 0.023), a low-bone mineral density (BMD) score (p = 0.023), and a higher number of fractures on baseline imaging (p = 0.013) were associated with a greater risk of subsequent vertebral fractures.

Conclusions The incidence of acute fractures after PVP is higher than that among patients treated conservatively. Decision-making regarding the adoption of this intervention should take into consideration the risk factors leading to a greater risk of subsequent vertebral fractures, such as a higher number of fractures at baseline imaging, low-BMD score, patient comorbidities, and steroid use.

Keywords

fracture - osteoporosis - vertebra - vertebroplasty

Notes

*Joint first authors.




Publication History

Article published online:
01 July 2021

© 2021. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 2000; 39 (12) 1410-1414
    CrossrefPubMedGoogle Scholar
  • 2 Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 2004; 25 (02) 175-180
    PubMedGoogle Scholar
  • 3 Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003; 226 (01) 119-124
    CrossrefPubMedGoogle Scholar
  • 4 Berlemann U, Ferguson SJ, Nolte LP, Heini PF. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 2002; 84 (05) 748-752
    CrossrefPubMedGoogle Scholar
  • 5 Lee WS, Sung KH, Jeong HT. et al. Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J 2006; 15 (12) 1777-1783
    CrossrefPubMedGoogle Scholar
  • 6 Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 2011; 14 (05) 561-569
    CrossrefPubMedGoogle Scholar
  • 7 Diamond TH, Bryant C, Browne L, Clark WA. Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 2006; 184 (03) 113-117
    CrossrefPubMedGoogle Scholar
  • 8 Wang HK, Lu K, Liang CL. et al. Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 2010; 11 (11) 1659-1665
    CrossrefPubMedGoogle Scholar
  • 9 Movrin I. Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy. Wien Klin Wochenschr 2012; 124 (9-10) 304-311
    CrossrefPubMedGoogle Scholar
  • 10 Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 2003; 114 (04) 257-265
    CrossrefPubMedGoogle Scholar
  • 11 Klazen CA, Lohle PN, de Vries J. et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 2010; 376 (97/46) 1085-1092
    CrossrefPubMedGoogle Scholar
  • 12 Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 2016; 95 (31) e4491
    CrossrefPubMedGoogle Scholar
  • 13 Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 2006; 27 (01) 217-223
    PubMedGoogle Scholar
  • 14 Lindsay R, Silverman SL, Cooper C. et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285 (03) 320-323
    CrossrefPubMedGoogle Scholar
  • 15 Lindsay R, Burge RT, Strauss DM. One year outcomes and costs following a vertebral fracture. Osteoporos Int 2005; 16 (01) 78-85
    CrossrefPubMedGoogle Scholar
  • 16 Xie W, Jin D, Wan C. et al. The incidence of new vertebral fractures following vertebral augmentation: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2015; 94 (37) e1532
    CrossrefPubMedGoogle Scholar
  • 17 Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 2003; 28 (10) 991-996
    CrossrefPubMedGoogle Scholar
  • 18 Zhang H, Xu C, Zhang T, Gao Z, Zhang T. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A meta-analysis. Pain Physician 2017; 20 (01) E13-E28
    CrossrefPubMedGoogle Scholar
  • 19 Zhang Z, Fan J, Ding Q, Wu M, Yin G. Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty: a systematic review and meta-analysis. J Spinal Disord Tech 2013; 26 (04) E150-E157
    CrossrefPubMedGoogle Scholar
  • 20 Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: an analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore) 2016; 95 (24) e3850
    CrossrefPubMedGoogle Scholar
  • 21 Yang W, Song J, Liang M, Cui H, Chen H, Yang J. Functional outcomes and new vertebral fractures in percutaneous vertebroplasty and conservative treatment of acute symptomatic osteoporotic vertebral compression fractures. World Neurosurg 2019; 131: e346-e352
    CrossrefPubMedGoogle Scholar
  • 22 Wang B, Guo H, Yuan L, Huang D, Zhang H, Hao D. A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking. Eur Spine J 2016; 25 (11) 3486-3494
    CrossrefPubMedGoogle Scholar
  • 23 Zuo XH, Zhu XP, Bao HG. et al. Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine (Baltimore) 2018; 97 (29) e11544
    CrossrefPubMedGoogle Scholar