Background: Vertebral cement augmentation is a commonly used procedure in patients with
vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease,
or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can
experience symptomatic relief following the procedure.
Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral
body compression fractures presenting for cement augmentation, and present their postoperative
outcomes.
Study Design: Retrospective cohort study.
Setting: Interventional pain practice in a tertiary care university hospital.
Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty
(VP) procedures in a 7-year period within our practice were evaluated through a search of the
electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive
preprocedural radiculopathy in our patients. Evaluation of each patient’s relative improvement
following the procedure, respective to the initial presence or absence of radicular symptoms
(including and above T10, above and below T10, and below T10) was included as a secondary
endpoint. Additional subanalysis was performed with respect to patients demographics, fracture
location, and primary indication for the procedure (osteoporosis, trauma, etc.).
Results: A total of 302 procedures were performed during this time period, encompassing
544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of
patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve
impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly
complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little
to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete
resolution, whereas patients with fractures above and below T10 were likely to not see any
resolution. Men and women without initial radiculopathy symptoms were more likely to see little
to no resolution, regardless of fracture location.
Limitations: This retrospective study used an electronic chart review of clinicians’ notes to
determine the presence of radiculopathy and their relative improvement following the procedure.
Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the
evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be
an important marker for those patients who may experience greater benefit from the procedure.
Key words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture,
spine, cement augmentation
A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral
Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture?
