Preventive vertebroplasty for prevention of post-vertebroplasty-new-onset adjacent vertebral compression fracture

Autor: Chao-Hsuan Yen, 顏昭璿
Rok vydání: 2011
Druh dokumentu: 學位論文 ; thesis
Popis: 100
Percutaneous vertebroplasty is a minimally invasive procedure that involves filling a fractured vertebral body with bone cement to relieve pain. It has now become a therapeutic option for the management of painful tumor or osteoporosis-related vertebral compression fracture with poor response to medical treatment. Percutaneous vertebroplasty has been shown to facilitate substantial pain relief and aid rehabilitation in up to 90% of patients, as early as 1 to 2 days after the intervention (1-5). However, some patients experience new vertebral compression fracture soon after the procedure (1-11). Post-vertebroplasty new-onset vertebral compression fracture often occurs on the adjacent vertebral bodies in about half of the cases, especially in the adjacent part of both adjacent vertebral bodies (1). We hypothesized that the risk of post-vertebroplasty new-onset adjacent vertebral compression fracture might be lowered by preventive vertebroplasty at the adjacent portion of both adjacent vertebral bodies. The object of this study was to evaluate the effects of preventive vertebroplasty for prevention of post-vertebroplasty new-onset adjacent vertebral compression fracture. Radiographs of 237 patients who had undergone percutaneous vertebroplasty because of vertebral compression fracture and received follow-up plain films of the thoracic and lumbar spine after vertebroplasty were retrospectively reviewed for the occurrence of post-vertebroplasty new-onset vertebral compression fracture from June 2000 to August 2006. All patients enrolled had osteoporosis, and patients with bone tumor were excluded. Patients in the non-preventive group (n=146) underwent therapeutic vertebroplasty only for the vertebral body with an unhealed fracture. The preventive group (n=91) received preventive vertebroplasty combined with therapeutic vertebroplasty. In preventive vertebroplasty, we injected bone cement into the caudal part of the cephalic adjacent vertebral body and cephalic part of the caudal adjacent vertebral body. We avoided dense packing of bone cement when performing preventive vertebroplasty. The adjacent vertebral body was excluded from preventive vertebroplasty if it was S1, or if it had a healed old fracture. We evaluated the prognosis of the uncemented normal adjacent vertebral bodies (next to a therapeutic vertebroplasty level and next to a preventive vertebroplasty level), and recorded any post-vertebroplasty new-onset adjacent fractures (superior or inferior to the cemented vertebral bodies) in the follow-up periods (Table 4-1). We also studied the cumulative numbers and percentages of patients with post-vertebroplasty new-onset vertebral compression fracture during different follow-up periods (4 years) and under different conditions, including “adjacent only” involving adjacent vertebral bodies only, “both” involving both adjacent and non-adjacent vertebral bodies, “non-adjacent only” involving non-adjacent vertebral bodies only, “any adjacent” involving any adjacent vertebral bodies (“adjacent only” plus “both”), “any non-adjacent” involving any non-adjacent vertebral bodies (“non-adjacent only” plus “both”), and “any vertebral compression fracture” involving any vertebral bodies (summation of “adjacent only”, “both” and “non-adjacent only” (Table 4-2). Among these 237 patients, 75 (21%) of the 357 adjacent vertebral bodies next to a therapeutic vertebroplasty level had post-vertebroplasty new-onset fracture. Only 4 (3.8%) of the 105 adjacent vertebral bodies next to a preventive vertebroplasty had post-vertebroplasty new-onset fracture (Table 4-1). In the non-preventive group, the incidence of “any vertebral compression fracture” at 4 years follow-up was 25%, 31% and 43%, respectively. In all of the patients with “any vertebral compression fracture” followed at 4 years by 18%, 24%, 28%, respectively. The incidences of ‘non-adjacent only” vertebral compression fracture, and “any non-adjacent” vertebral compression fracture showed no significant difference between these 2 groups. We concluded that preventive vertebroplasty for the adjacent portion of both adjacent vertebral bodies combined with therapeutic vertebroplasty is effective in the prevention of the propagation of post-vertebroplasty new-onset adjacent vertebral compression fracture.
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