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

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

• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 15 Lindsay R, Burge RT, Strauss DM. One year outcomes and costs following a vertebral fracture. Osteoporos Int 2005; 16 (01) 78-85
• 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
• 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
• 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
• 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
• 20 Saracen A, Kotwica Z. Complications of percutaneous vertebroplasty: an analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore) 2016; 95 (24) e3850
• 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
• 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
• 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