Background: Previous studies have reported a high incidence of re-collapse of the augmented
vertebrae after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral
compression fractures (OVCFs) with intravertebral vacuum cleft (IVC) during long-term followup. Previous IVC might be considered an important predisposing factor for re-collapse, but the
prior studies could not find a significant correlation.
Objective: To determine the incidence and distribution characteristics of IVCs and to further
assess IVCs in their varied locations. To assess the long-term therapeutic efficacy of PVA for
OVCFs with IVC.
Study Design: A retrospective cohort study.
Setting: Department of spinal surgery, an affiliated hospital of a medical university.
Methods: A retrospective review was performed on 594 patients who underwent PVA to
treat OVCFs from January 2010 to December 2013. Eighty-two patients with the IVC sign were
enrolled in the study. The follow-up period was a minimum of 2 years. The difference between
IVC and non-IVC patients was compared. Comparisons of the radiological and clinical findings
at varied IVC locations were made pre-operatively and post-operatively (immediate, at one year,
and at 2 years).
Results: IVC incidence correlated with older patient age and severe demineralization.
Other baseline parameters showed no significant differences. The rate of cement leakage
and vertebral fracture was significantly lower in the IVC groups than in the non-IVC groups
intraoperatively. There was no significant difference in the incidence of cement leakage or
adjacent vertebral fractures between the 3 IVC groups. In the immediate postoperative period,
all patients benefited from significant improvement in vertebral body height and kyphotic angle
correction. However, significant re-collapse was observed at the 2-year post-operative followup for the IVC patients when compared to the non-IVC patients. Among the 3 IVC groups, the
most severe re-collapse was observed with inferior endplate IVCs. Superior endplate IVCs and
IVCs extending to both endplates demonstrated only mild re-collapse at the 2-year follow-up.
Limitation: Due to the infrequency of this process, the number of patients with IVCs was
small.
Conclusion: PVA treatment was initially effective in all patients with OVCFs. However,
significant re-collapse of the augmented vertebrae with IVCs, especially those with inferior
endplate IVCs, was found with long-term follow-up.
Intravertebral Vacuum Cleft and Its Varied
Locations within Osteoporotic Vertebral
Compression Fractures: Effect on Therapeutic
Efficacy
