Preventive Vertebroplasty for Adjacent Vertebral Bodies: A Good Solution to Reduce Adjacent Vertebral Fracture after Percutaneous Vertebroplasty

BACKGROUND AND PURPOSE: Adjacent VCF frequently occurs after percutaneous vertebroplasty. Our aim was to evaluate PrVP in the prevention of PVNO-adjacent VCF.

MATERIALS AND METHODS: Radiographs of 68 patients who initially presented with a single-level unhealed fracture and underwent vertebroplasty were retrospectively reviewed for the occurrence of PVNO fracture. Patients in the nonpreventive group (n = 33) underwent TVP only for a vertebra with an unhealed fracture. The preventive group (n = 35) underwent PrVP combined with TVP. We injected bone cement into the caudal part of the superior adjacent vertebra and the cephalic part of the inferior adjacent vertebra to perform PrVP.

RESULTS: The incidences of PVNO fracture in adjacent vertebra next to a vertebra cemented at the patient's first vertebroplasty (within 6 months: 24% versus 3%, P = .012; within 1 year: 30% versus 3%, P = .006; >4 years: 39% versus 3%, P = .006) markedly decreased in the preventive group compared with the nonpreventive group. PVNO fracture was found in 26% of vertebrae adjacent to the first TVP level in the nonpreventive group and in 2% of vertebrae adjacent to a PrVP level in the preventive group after inclusion of all PrVP procedures. Approximately 33% of patients in the nonpreventive group underwent repeat vertebroplasty, mainly due to adjacent fractures. Only 3% of patients in the preventive group underwent repeated procedures. None of the vertebrae cemented for PrVP or TVP developed PVNO refracture.

CONCLUSIONS: Preventive vertebroplasty for the adjacent vertebra combined with TVP for the fractured vertebra is effective in the prevention of propagation of PVNO adjacent fractures, thus reducing the necessity of multiple repeat vertebroplasty procedures.