Korean J Neurotrauma.  2013 Apr;9(1):17-22. 10.13004/kjnt.2013.9.1.17.

Clinical Features of Percutaneous Hemivertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures

• Yang JC
• Park KH
• Kim TW
• Ryu J
• Chi MP
• Kim JO

• KMID: 1427756
• DOI: http://doi.org/10.13004/kjnt.2013.9.1.17

Abstract

OBJECTIVE
Unilateral percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral compression fractures (VCFs). However, bone cement may fail to fill both hemivertebra from the single needle. We assessed the radiographic and clinical outcome of hemivertebroplasty (HVP) and evaluated the factors that affect subsequent VCFs after HVP.
METHODS
Fifty two patients who underwent HVP were reviewed. VCFs were identified based on clinical and radiological findings. The patients were grouped into two groups: 1) no subsequent VCFs, 2) subsequent VCFs. We evaluated the association between age, sex, body mass index (BMI) and bone mineral density (BMD) and subsequent VCFs. We also assessed the impact of location, type and grade of fracture, endplate fracture, burst fracture, bone cement volume on subsequent VCFs. We analyzed the compression ratio, wedge angle, kyphotic angle, and visual analogue scale (VAS) score in both groups.
RESULTS
There were no significant differences in age, gender, BMI, and BMD between two groups. No significant difference was also found in pre-existing VCF, location, type and grading of fracture, endplate fracture, burst fracture, amount of bone cement, and radiological findings such as compression ratio, wedge angle, and kyphotic angle between two groups. The final mean VAS scores of patients with or without subsequent VCFs were 3.11 and 4.02, respectively.
CONCLUSION
No major risk factors for the subsequent VCFs after HVP were found. However, we identified adjacent fractures, refractures, and remote fractures after HVP in chronological order. Therefore, long-term follow-up is necessary to evaluate the effectiveness of HVP to osteoporotic VCFs.

Keyword

Osteoporotic fracture; Vertebroplasty; Hemivertebrae; Subsequent fracture; Risk factor

MeSH Terms

Body Mass Index
Bone Density
Follow-Up Studies
Fractures, Bone
Fractures, Compression
Humans
Needles
Osteoporotic Fractures
Risk Factors
Vertebroplasty

Figure

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  FIGURE 1. An anterior-posterior view of the spine shows that bone cement is present predominantly in the left side of vertebral body.

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  FIGURE 2. Measurement of the vertebral compression ratio by the following formula, [(H1+H3)/2-H2]/[(H1+H3)/2]. H1: anterior vertebral height of upper vertebra, H2: anterior vertebral height of fracture level, H3: anterior vertebral height of lower vertebra.

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  FIGURE 3. Measurement of wedge angle (W) and kyphotic angle (K). The angle between the superior endplate of the vertebral body just above the fracture and the inferior endplate of the fractured vertebral body is determined as wedge angle and kyphotic angle is determined as measured angle between the superior endplate of the vertebral body above and the inferior endplate of the vertebra below the fractured vertebra on the lateral radiograph (K).

Reference

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