Percutaneous Vertebroplasty-Induced Adjacent
Vertebral Compression Fracture

Background: The risks associated with percutaneous vertebroplasty (PV) are low. Patients show marked improvement and are able to rapidly resume normal activities after PV. The sudden development of postoperative vertebral compression fracture (VCF) is a common complication, and additional PV is frequently performed in these cases. However, there have been no studies reporting acute compression fractures of an adjacent vertebra immediately after PV. Objective: This case report presents a rare case in which the patient had to undergo a second PV because of PV-induced adjacent VCF. Further, we review previous studies and discuss the possible pathogenesis of this rare complication. Study Design: Case report. Setting: Pain management clinic. Methods: A 62-year-old woman presented with a severe pain in the lower back, which started after she slipped. A radiograph showed severe vertebral collapse with a vertebral vacuum cleft in the T12 vertebral body. T1-weighted magnetic resonance imaging showed low signal intensity in T12, suggesting acute VCF, but the signals from the other vertebrae were normal. Results: The patient underwent PV at T12. When the cannula was inserted into the fracture line of the vertebral body, reduction of the collapsed T12 was developed. Although the postoperative course was uneventful, the patient’s pain did not resolve. Postoperative radiographic image obtained 4 hours after the PV showed reduction of T12 and adjacent acute VCF in T11. We performed a second PV at T11. However, 2 weeks later, adjacent acute VCF in L1 was developed and PV was performed. Limitations: This report describes a single case. Conclusion: To the best of our knowledge, this is the first case report of adjacent VCF that developed almost immediately after PV. Although the exact mechanism underlying this rare complication remains unclear, we assume that the VCF was induced by PV, although this was not proven. However, we suggest that the insertion of the cannula into the fracture line induced the iatrogenic dynamic mobility of the fractured vertebra. Reduction was caused by the cannula and positional gravity. The upward reduction may have had an effect on the upper and adjacent vertebrae. Key words: Compression fractures, vertebroplasty, cannula, complication.

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Treatment of subacute osteoporotic vertebral compression fractures with percutaneous vertebroplasty: A case report

Vojnosanitetski pregled ◽

10.2298/vsp170130037a ◽

2018 ◽

Vol 75 (10) ◽

pp. 1049-1053

Author(s):

Zoran Aleksic ◽

Ivana Stankovic ◽

Ivana Zivanovic-Macuzic ◽

Dejan Jeremic ◽

Aleksandar Radunovic ◽

...

Keyword(s):

Case Report ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Minor Trauma ◽

Osteoporotic Vertebral Compression Fractures ◽

Invasive Approach ◽

Compression Fractures ◽

Thoracic Spinal

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3?6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat ?less mature? fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

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Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

Case Reports in Orthopedics ◽

10.1155/2015/870810 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Guido Zarattini ◽

Adam Farrier ◽

Federico Sibona

Keyword(s):

Percutaneous Vertebroplasty ◽

Rare Complication ◽

Cement Leakage ◽

Clonic Seizure ◽

Tonic Clonic Seizure ◽

Leg Pain ◽

Compression Fractures ◽

First Case ◽

Seizure Syndrome ◽

Osteoporotic Compression Fractures

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty.Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures.Study Design. Case report.Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis.Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management.Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality.

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Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture

Acta Radiologica ◽

10.1080/02841850510021058 ◽

2005 ◽

Vol 46 (3) ◽

pp. 280-287 ◽

Cited By ~ 17

Author(s):

K.‐R. Han ◽

C. Kim ◽

J.‐S. Eun ◽

Y.‐S. Chung

Keyword(s):

Vertebral Compression Fracture ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Safe Procedure ◽

Compression Fractures ◽

Clinical Complications ◽

Technical Procedure ◽

One Year ◽

Changes Over Time

Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid‐thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4–T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow‐ups showed that pain intensity had decreased by 50% one day after operation and later by 70–80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8±1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid‐thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.

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Treatment of Osteoporotic Vertebral Compression Fracture with Target-Anchored Vertebral Body Plasty

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2019.2073 ◽

2019 ◽

Vol 9 (8) ◽

pp. 1081-1085

Author(s):

Liu Yang ◽

Xiangbei Qi ◽

Tao Lei ◽

Jingtao Zhang ◽

Junming Cao

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Target Group ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Traditional Group ◽

Compression Fractures ◽

Fracture Area

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

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Percutaneous Vertebroplasty for Osteoporotic Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/559 ◽

2007 ◽

Vol 4;10 (7;4) ◽

pp. 559-663

Author(s):

Suhail Afzal

Keyword(s):

Back Pain ◽

Pain Relief ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Percutaneous Injection ◽

Compression Fractures ◽

Vas Score

Background: Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. Purpose: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. Design: A prospective study. Materials and Methods: A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. Results: The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. Conclusion: Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain. Key words: Compression fracture, osteoporosis; pain, vertebroplasty, polymethylmethacrylate

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Percutaneous Vertebroplasty in Osteoporotic Vertebral Body Compression Fracture

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2001.44.2.145 ◽

2001 ◽

Vol 44 (2) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Hyuk Jung Kim ◽

Seon Kyu Lee ◽

Hee Young Hwang ◽

Hyung Sik Kim ◽

Joon Seok Ko ◽

...

Keyword(s):

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Body Compression Fracture

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The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

BioMedical Engineering OnLine ◽

10.1186/s12938-021-00894-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Xiaowei Liu ◽

Hui Wang ◽

Yang Zhang ◽

Mingling Wang ◽

Yujin Qiu ◽

...

Keyword(s):

Shock Wave ◽

Postmenopausal Women ◽

Percutaneous Vertebroplasty ◽

Reduction Rate ◽

Compression Fracture ◽

Analgesic Efficacy ◽

Small Sample ◽

Compression Fractures ◽

Extracorporeal Shock Wave ◽

Post Operation

Abstract Background To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. Methods The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. Results Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

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