Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures: A 4-year Follow-up.

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: New vertebral compression fracture (NVCF) is a highly potential risk after percutaneous vertebroplasty (PVP). The study aimed at analyzing the incidence and risk factors of NVCF and preventing its development.

SUMMARY OF BACKGROUND DATA: PVP is widely used and highly effective technique for reducing pain caused by an osteoporotic vertebral compression fracture. However, there is a great deal of debate about whether PVP is associated with NVCF, and many risk factors of NVCF have been hypothesized.

METHODS: From January to December 2008, a total of 198 patients (176 women, 22 men; mean age, 76.6±0.5 y) who underwent PVP at 270 levels for painful osteoporotic VCF were retrospectively analyzed during a 4-year follow-up. The following parameters were evaluated: NVCF incidence and average time, body mass index (BMI), smoking history, the existence of trauma, and bone mineral density (BMD) before and after PVP. Cement location, intradiscal leakage, distribution pattern, kyphotic angle, sagittal index, compression ratio, injected cement volume, and numbers of fractures and thoracolumbar junction fractures were analyzed.

RESULTS: During follow-up, 34 patients (17.2%) sustained symptomatic NVCF for 4-year follow-up. All 34 patients with NVCF had lower BMD than that before initial PVP. For adjacent VCF, multivariable analysis showed that a higher risk of NVCF after vertebroplasty was associated with a larger number of VCF (P=0.025) and lower BMI (P=0.045), whereas for remote VCF, the risk of NVCF was higher in patients who had not experienced trauma and lower BMD (P=0.045). None of the radiographic evaluation values were related to the occurrence of NVCF.

CONCLUSIONS: The most important elements related to reducing NVCF were treating osteoporosis and improving BMD and BMI. More aggressive BMD and BMI correction is more important than the vertebroplasty technique.