I acknowledged the usefulness of percutaneous vertebroplasty in patients with osteoporotic vertebral fracture when I attended RSNA conferences and ASNR workshops before 2000. Therefore, I decided to introduce this technique in Taiwan. Professor Jacques Edgar Dion was very kind and accepted our invitation to deliver lectures and perform live demonstrations of percutaneous vertebroplasty in Taiwan when I was the president of the Neuroradiological Society of Taiwan in 2000.

Among patients who received percutaneous vertebroplasty between 2000–2004, about 48% developed recurrent back pain because of new post-vertebroplasty fracture after an interval of no pain. About 63% of these new fractures occurred in an adjacent vertebra, next to the level that received vertebroplasty.¹ Adjacent vertebral fracture was an important cause of recurrent back pain; therefore, we decided to do something to stop this. In addition to treatment of osteoporosis and other supportive measures, prophylactic cementing to adjacent vertebrae was considered. However, cementing adjacent vertebrae may not halt propagation of new fracture involving farther adjacent vertebrae if a large amount of bone cement is used in the adjacent vertebral body. Previous reports and our own study found that occurrence of adjacent vertebral fracture is related to the spatial location of the implanted cement—about 7%, 29%, and 44%, respectively, for cement remaining inside the vertebral body, reaching the endplate, and reaching the disk space.² Therefore, we designed the technique of prophylactic cementing for the adjacent vertebrae by placing cement in the adjacent part of the adjacent vertebral bodies and leaving the distal part of the adjacent vertebrae uncemented.

After many years of performing our prophylactic vertebroplasty, we decided to review our cases so that this technique can be adopted by other doctors performing spinal augmentation.³

With this prophylactic procedure we spend approximately one hour more for each patient because we add two levels of adjacent vertebrae for cementing. These patients can be free from recurrent severe back pain and vertebral deformity caused by new adjacent vertebral fracture. Therefore, the time and money spent is justified. With this technique, the occurrence of postvertebroplasty new adjacent vertebral fracture is reduced from 26% for vertebrae next to the therapeutic cemented level to 2% for vertebrae next to a prophylactic cemented level.³

Some adjacent fracture after vertebroplasty may not be caused by the implanted bone cement. We have found cases of spontaneous occult fracture in vertebrae adjacent to the fractured level with no prior vertebroplasty. We are collecting more cases for future publication, and I just presented 9 adjacent vertebral occult fractures at the last ARRS meeting (2013), which took place in Washington, DC.

References

1. Chang CY, Teng MMH, Wei CJ, et al. Percutaneous vertebroplasty for patients with osteoporosis: a one-year follow-up. Acta Radiol 2006;47:568-73. doi: 10.1080/02841850600690405
2. Sun YC, Teng MMH, Yuan WS, et al. Risk of post-vertebroplasty fracture in adjacent vertebral bodies appears correlated with the morphologic extent of bone cement. J Chin Med Assoc 2011;8:357-62. doi: 10.1016/j.jcma.2011.06.008
3. Yen CH, Teng MMH, Yuan WH, et al. Preventive Vertebroplasty for Adjacent Vertebral Bodies: A Good Solution to Reduce Adjacent Vertebral Fracture after Percutaneous Vertebroplasty. AJNR Am J Neuroradiol 2012;33:826-32. doi: 10.3174/ajnr.A2898

 

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