Rationale and Objectives
We investigated the efficacy of prophylactic cement injection into the vertebral body adjacent to fractured vertebra to prevent new fractures after percutaneous vertebroplasty (PV).
Materials and Methods
Between February 2002 to August 2004, PV was performed for osteoporotic compression fractures in 89 consecutive patients. All patients underwent PV for only fractured vertebrae. Between September 2004 and October 2006, we performed prophylactic cement injection for 155 patients, with cement injected into the non-fractured vertebra adjacent to the fractured vertebra, immediately above the fractured vertebra in the same procedure. We evaluated the frequency of new vertebral fractures and the efficacy of prophylactic therapy.
Results
In the non-prophylactic group, 15 of 89 patients (16.8%) developed new fractures within 3 months and 20 of 89 patients (22.4%) developed new painful compression fractures within a year after the first PV. These fractures occurred mostly in adjacent vertebra, particularly in the vertebra immediately superior to the treated one and occurred in the lower thoracic and upper lumbar spine. In the prophylactic group, 7 of 155 patients (4.5%) developed new compression fractures within 3 months and 15 of 155 patients (9.7%) developed new compression fractures within 1 year. Statistical analysis showed that fewer new fractures developed in the prophylactic group than in the non-prophylactic group at both 3 months ( P = .0020, Fisher’s exact test) and 1 year ( P = .0079).
Conclusions
Prophylactic cement injection into non-fractured vertebrae adjacent to fractured vertebrae may prevent new compression fractures after vertebroplasty for osteoporotic patients.
The first report of percutaneous vertebroplasty (PV) was published in 1987 by Galibert et al, who treated a patient with a giant angioma in the second cervical vertebra ( ). Ever since, PV has been performed all over the world for tumor or osteoporosis-related compression fractures, particularly spinal compression fractures with difficult pain control. Many studies have demonstrated the therapeutic effects and complications of PV ( ). In particular, PV is a highly effective and quick-responding measure against acute and subacute spinal compression fractures, and is effective in relieving pain from prolonged therapy due to pseudoarthrosis ( ).
Even if PV improves the activities of daily living and sufficiently relieves pain, new spinal compression fractures often occur soon after therapy, causing back pain to recur. Because of recurrent painful compression fractures, second or multiple treatments are sometimes needed ( ).
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Materials and methods
Subjects
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PV Procedures
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Analysis
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Results
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Table 1
Statistical Analysis (Fisher’s exact test)
New Fracture Within 3 Months ( n = 244) New Fracture Within a Year ( n = 244) Non-prophylactic group 15/89 (16.8%) 20/89 (22.4%) Prophylactic group 7/155 (4.5%) 15/155 (9.7%)P value .0020 .0079 Relative risk 0.27 (0.11–0.63) 0.43 (0.23–0.80)
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Discussion
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Conclusion
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Acknowledgments
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