Percutaneous Vertebroplasty for Symptomatic Osteoporotic Vertebral Compression Fracture Adjacent to Lumbar Instrumented Circumferential Fusion

Full article available online at Healio.com/Orthopedics. Search: 20120621-26 Percutaneous Vertebroplasty for Symptomatic Osteoporotic Vertebral Compression Fracture Adjacent to Lumbar Instrumented Circumferential Fusion Shih-Chieh Yang, MD, PhD; hung-Shu Chen, MD, PhD; Yu-hSien Kao, MD; Ching-hou Ma, MD; Yuan-Kun Tu, MD; Kao-Chi Chung, PhD The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors’ institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky’s criteria were used to compare clinical outcomes preand postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients’ visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease. Drs Yang, Chen, Kao, Ma, and Tu are from the Department of Orthopaedic Surgery and Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung County, and Dr Chung is from the Institute of Biomedical Engineering, National Cheng-Kung University, Tainan City, Taiwan, Republic of China. Drs Yang, Chen, Kao, Ma, Tu, and Chung have no relevant financial relationships to disclose. Correspondence should addressed to: Hung-Shu Chen, MD, PhD, Department of Orthopaedic Surgery and Anesthesiology, E-Da Hospital, I-Shou University, 1, E-Da Rd, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of China (edaanebone@gmail.com). doi: 10.3928/01477447-20120621-26 e1079 Figure: Postoperative anteroposterior (A) and lateral (B) radiographs showing good augmentation with polymethylmethacrylate bone cement after percutaneous vertebroplasty of L3. A B