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Cement Distribution Affects Compression Fractures in Adjacent Vertebral Bodies

September 29, 2009
Written by: , Filed in: Musculoskeletal Radiology, Neuroradiology
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Background
Vertebroplasty is widely used to treat back pain after compression fractures. It stabilizes the vertebral body. However, some patients experience new compression fractures, often in adjacent vertebrae after vertebroplasty, soon after the procedure. The authors speculate that the cement distribution may influence the occurrence.

The Study

A recent study was conducted to investigate the relationship between cement distribution pattern and the occurrence of new compression fractures after vertebroplasty.

The cleft pattern is associated with a significantly higher rate of adjacent vertebral body compression fractures than is the trabecular pattern.

Participants
76 patients with 163 osteoporotic compression fractures were included.

Methodology
Patients had anterior and lateral radiographs of the spine and a spine MRI and CT. Vertebral bodies were classified into 2 groups according to the cement distribution pattern on radiographs, which were a cleft (compact and solid cement filling) and trabecular pattern (sponge-like).

Pain was assessed with a visual analog scale, ranging from 0 to 10. Pre-procedural and post-procedural pain was assessed. Follow-up was performed 1, 4, 10, 22, and 34 months after hospital discharge. The medical history was recorded, and a physical examination was performed. If pain was present, MRI was obtained as necessary.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

<B>Results</B>
40 vertebrae had a cleft or solid pattern of filling (type C); 123 vertebrae had a trabecular (type T) pattern. There was an increased incidence of cleft pattern at the thoracolumbar junction vertebrae. The injected cement volume was significantly larger in the cleft group (group C, 4.5 mL; group T, 3.7 mL; P =0.01). Pain improvement did not differ significantly between groups. Mean follow-up period was 16.7 months (range, 1 to 34 months).

Of the 34 patients in group C, 17 experienced a new fracture (50%) versus only 11 of 42 patients in group T (26.2%); this difference was significant (P =0.03). Furthermore, adjacent fractures were found in 44% of patients with a cleft pattern and in only 16.7% of patients with a trabecular pattern (P =0.009). The time interval for new compression fractures did not vary significantly in both groups.

<B>Conclusions</B>
Cement distribution does not affect clinical response but does affect development of new compression fractures in adjacent vertebral bodies.

<B>Reviewer’s Comments</B>
The amount of injected cement is thought to restore vertebral body height. The increased height could increase soft-tissue tension around the vertebral body, causing an increased load on the adjacent vertebrae.

The cleft group also had longer fracture duration than did group T, causing more stress onto the soft tissues after treatment. The study did not assess the presence of cement leakage into the adjacent disc, which is a known factor for compression fractures.

<b>Author:</B> Cornelia Wenokor, MD
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Reference:</B>
Tanigawas N, Kom, et al. <b>Relationship Between Cement Distribution Pattern and New Compression Fracture After Percutaneous Vertebroplasty.</b> <i>AJR;</i> 2007; 189 (December): W348-W352.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

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