Korean J Pain.  2013 Jan;26(1):94-97. 10.3344/kjp.2013.26.1.94.

Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea. clonidine@empal.com

Abstract

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

Keyword

refracture; repeat; vertebral compression fractures; vertebroplasty

MeSH Terms

Female
Flank Pain
Fractures, Compression
Humans
Lumbar Vertebrae
Polymethyl Methacrylate
Spine
Vertebroplasty
Polymethyl Methacrylate

Figure

  • Fig. 1 AP (A) and lateral (B) radiographs showing augmented 1st and 4th lumbar vertebral bodies filled with 2 ml and 2.5 ml of PMMA, respectively. The small volume injectates were unevenly distributed into the small portion of fractured vertebrae.

  • Fig. 2 In the pre-VP image (A), the collapse of vertebral body and the low-signal intensity in the anterior part of L1 represented the acute vertebral compression fractures. Comparing to the pre-VP image, the T1 and T2 weighted images a month after the first VP (B and C, respectively) showed slightly increased vertebral collapse and kyphotic angle, and an increase in low-signaled area to the posterior part of the L1 vertebral body, which are viewed as the refracture of L1.

  • Fig. 3 AP (A) and lateral (B) radiographs after repeat VP in the L1 vertebral body. Bone cement was evenly distributed into the fractured vertebra without cement leakage or migration of previous injectate.


Reference

1. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992; 13(Suppl 2):S27–S31. PMID: 1627411.
Article
2. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999; 26:2222–2228. PMID: 10529144.
3. Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976). 2000; 25:923–928. PMID: 10767803.
Article
4. Choi Y, Han HC, Lim KJ. Pulmonary embolism after percutaneous vertebroplasty with polymethylmethacrylate: a case report. J Korean Pain Soc. 2002; 15:190–193.
5. Kim DH, Kim KH, Kim YC. Minimally invasive percutaneous spinal techniques. 2011. Pennsylvania: Elsevier;p. 259–276.
6. Lin WC, Lee YC, Lee CH, Kuo YL, Cheng YF, Lui CC, et al. Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis. Eur Spine J. 2008; 17:592–599. PMID: 18204942.
Article
7. Lin CC, Shen WC, Lo YC, Liu YJ, Yu TC, Chen IH, et al. Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol. 2010; 194:1323–1329. PMID: 20410421.
Article
8. Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976). 2001; 26:1537–1541. PMID: 11462082.
9. Luo J, Daines L, Charalambous A, Adams MA, Annesley-Williams DJ, Dolan P. Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976). 2009; 34:2865–2873. PMID: 20010394.
10. Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2006; 27:1933–1937. PMID: 17032870.
11. Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol. 2009; 30:1835–1839. PMID: 19713320.
Article
12. Han IH, Chin DK, Kuh SU, Kim KS, Jin BH, Yoon YS, et al. Magnetic resonance imaging findings of subsequent fractures after vertebroplasty. Neurosurgery. 2009; 64:740–744. PMID: 19349832.
Article
13. He SC, Teng GJ, Deng G, Fang W, Guo JH, Zhu GY, et al. Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2008; 33:640–647. PMID: 18344858.
Article
14. Kim DJ, Kim TW, Park KH, Chi MP, Kim JO. The proper volume and distribution of cement augmentation on percutaneous vertebroplasty. J Korean Neurosurg Soc. 2010; 48:125–128. PMID: 20856660.
Article
Full Text Links
  • KJP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr