The proper volume and distribution of cement augmentation on percutaneous vertebroplasty.

OBJECTIVE The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. METHODS A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. RESULTS None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. CONCLUSION Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.

[1]  M. Adams,et al.  Vertebroplasty: Only Small Cement Volumes Are Required to Normalize Stress Distributions on the Vertebral Bodies , 2009, Spine.

[2]  F. Al-Ali,et al.  Vertebroplasty: What Is Important and What Is Not , 2009, American Journal of Neuroradiology.

[3]  I. Han,et al.  MAGNETIC RESONANCE IMAGING FINDINGS OF SUBSEQUENT FRACTURES AFTER VERTEBROPLASTY , 2009, Neurosurgery.

[4]  Chun-Kun Park,et al.  The prognostic factors influencing on the therapeutic effect of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures. , 2009, Journal of Korean Neurosurgical Society.

[5]  T. Gross,et al.  Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study , 2009, Osteoporosis International.

[6]  Po-Liang Lai,et al.  New vertebral fracture after vertebroplasty. , 2008, The Journal of trauma.

[7]  June Ho Lee,et al.  Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. , 2008, Journal of neurosurgery. Spine.

[8]  Yan Chevalier,et al.  Cement Distribution, Volume, and Compliance in Vertebroplasty: Some Answers From an Anatomy-Based Nonlinear Finite Element Study , 2008, Spine.

[9]  Wei-Che Lin,et al.  Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis , 2008, European Spine Journal.

[10]  E. Schneider,et al.  Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement , 2007, European Spine Journal.

[11]  Nico Verdonschot,et al.  The Influence of Endplate-to-Endplate Cement Augmentation on Vertebral Strength and Stiffness in Vertebroplasty , 2007, Spine.

[12]  Phillip Pollintine,et al.  Mechanical efficacy of vertebroplasty: influence of cement type, BMD, fracture severity, and disc degeneration. , 2007, Bone.

[13]  D. Kallmes,et al.  The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. , 2006, AJNR. American journal of neuroradiology.

[14]  D. Kallmes,et al.  Does vertebroplasty cause incident vertebral fractures? A review of available data. , 2006, AJNR. American journal of neuroradiology.

[15]  D. Kallmes,et al.  New fractures after vertebroplasty: adjacent fractures occur significantly sooner. , 2006, AJNR. American journal of neuroradiology.

[16]  M. Syed,et al.  New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. , 2005, AJNR. American journal of neuroradiology.

[17]  S. Belkoff.  Biomechanics of Vertebroplasty , 2003 .

[18]  Sean Molloy,et al.  The Effect of Vertebral Body Percentage Fill on Mechanical Behavior During Percutaneous Vertebroplasty , 2003, Spine.

[19]  Sang Gu Lee,et al.  Complication of the Augmented Vertebral Body after Percutaneous Vertebroplasty in Patients with Osteoporotic Compression Fracture: Hammer Effect: Preliminary Report. , 2003 .

[20]  T. Keaveny,et al.  Effects of Bone Cement Volume and Distribution on Vertebral Stiffness After Vertebroplasty , 2001, Spine.

[21]  S. Belkoff,et al.  The Biomechanics of Vertebroplasty: The Effect of Cement Volume on Mechanical Behavior , 2001, Spine.

[22]  K T Ison,et al.  The strengthening effect of percutaneous vertebroplasty. , 2000, Clinical radiology.