Percutaneous Vertebroplasty Following Postural Reduction in Unstable Vertebra Plana; Is it a Contraindication?

Kim, Seok Won; Lee, Seung Meung; Shin, Ho; Kim, Hyun Sung

Abstract

OBJECTIVE
Severe vertebral body collapse (vertebra plana) is considered a contraindication to vertebroplasty by most authors. The purpose of this study is to determine the efficacy of vertebroplasty in treating severe compression fracture patients with osteoporosis.
METHODS
16 patients underwent 18 vertebroplasties following postural reduction for vertebra plana. The fractures were defined vertebrae that have collapsed to more than 75% of their original height. Imaging and clinical features were analyzed, including involved vertebrae level, vertebral height after postural reduction for 2 days, injected cement volume, clinical outcome and complications.
RESULTS
Involved veretebra were located from level T7 to L4. Vertebral body collapse averaged 79% (range 12~25%) of the original height. After pillow reduction for 2 days, vertebral body height increased 35% of the original height (range 15~45%). The kyphotic wedge was 12 degrees before procedure and was decreased 7.0 degree after vertebroplasty. The mean injected cement volume was 3.8 ml (range 2.0~4.9 ml). After the procedure, surgical outcome was excellent in 8 (50%) of 16 patients, good in 7 (42%) and unchanged in one (8%). The mean pain score (VAS score) prior to vertebroplasty was 8.3 and it changed 3.2 after the procedure. Cement leakage to the adjacent disc (5 cases) and paravertebral soft tissues (4 cases) developed but there were no major complications.
CONCLUSION
We propose that vertebra plana due to osteoporosis is not a contraindication to vertebroplasty. Vertebroplasty following postural reduction for severe compression fracture is safe and effective treatment.