Penetration approach for repeat vertebroplasty through the previously impacted bone cement.

Dear Editor, Vertebroplasty (VP) and kyphoplasty (KP) are effective treatments for painful vertebral compression fractures (VCFs) [1,2]. Although not common, subsequent refracture in the previously augmented vertebra causes persistent or recurrent pain [3]. Some reports have shown that repeat VP can control pain caused by refractures [3–5]. However, repeat VP is challenging because the previously impacted bone cement blocks the fluoroscopic views and access of procedure needles. A 57-year-old woman presented with severe pain (visual analog scale [VAS] 8/10) in her lower back and both thighs, which left her unable to sit or walk. She had a history of rectal cancer that had metastasized to the liver and lungs. Six months previously, metastasis to the fourth lumbar vertebra was detected and KP was performed (Figure ⇓). After the procedure, her pain reduced from VAS 8 to 2, but it recurred a week before her visit to our clinic. Magnetic resonance imaging (MRI) revealed further metastatic progression in the L4 vertebral body, and bone cement was located in front of the left pedicle (Figure ⇓). After the failure of conservative treatments, we undertook repeat VP with a …