Analysis of Risk Factors for Secondary New Vertebral Compression Fracture Following Percutaneous Vertebroplasty in Patients with Osteoporosis.

OBJECTIVE: The aim of this article was to analyze risk factors for secondary new vertebral compression fractures (SNVCFs) after percutaneous vertebroplasty in patients with osteoporosis.

METHODS: We investigated medical records and radiologic images of patients undergoing percutaneous vertebroplasty for osteoporotic vertebral compression fracture between October 2009 and September 2014. We assessed patients' age, past medical history, and bone mineral content using computed tomography. Procedure-specific outcomes were assessed, including ratio of injected bone cement to vertebral body volume, bone cement distribution in the vertebral body (to identify degree of consistency in bone cement injection), presence of bone cement leakage into adjacent disc space, segmental kyphosis, and time interval between first and second fracture events.

RESULTS: Percutaneous vertebroplasty was performed in 293 patients (60 men and 233 women) with 336 affected levels. Of this cohort, 34 (14.6%) patients sustained SNVCFs. We compared patients in 2 groups: patients who experienced SNVCFs, and patients who did not experience fractures. Significant differences were identified in bone mineral content (P = 0.000) and bone cement distribution (P = 0.000). Patients exhibiting bone cement leakage into disc space revealed a higher incidence of SNVCF than patients without leakage (P = 0.039).

CONCLUSIONS: Poor bone mineral content can be a predictive factor of SNVCFs. To prevent SNVCFs, bone cement should be injected as evenly as possible into the vertebral body. Bone cement leakage into the disc space should be avoided.