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1、 Percutaneous vertebroplasty (PVP) is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures (OVCFs). However,some patient populations experience recurrent vertebralfracture after initial successful procedure. There are a lot of literatures about the effectiveness o
2、f this procedure but few concerning the development of recurrent, new compression fracture. Background The purpose of our study was to investigate the factors affecting new compression fractures in vertebral bodies adjacent to or remote from those previously treated with PVP.Objective Between Septem
3、ber 1999 to December 2001, we performed percutaneous vertebroplasty in 311 consecutive patients with symptomatic OVCFs. Overall follow-up data in the remaining 244 individuals (78%) were available for this study. The overall numbers of the treated vertebrae were 382 levels. There were 37 male and 20
4、7 female patients (mean age 66.4 years) and the mean follow up duration was 52.5 months (range 3867 months).Materials and methods A GROUP : A GROUP : Those patients who developed new, acute/subacute symptomatic OVCFs during the follow up period were grouped into new symptomatic compression fracture.
5、 B GROUP : B GROUP : The others, who did not experience further symptomatic OVCFs were considered as control group.Materials and methods parameters:age, gender, the date initial vertebroplasty was performed, vertebral level(s) and the number of vertebra treated, anterior-to-posterior body height rat
6、io of the fractured vertebra，amount of PMMA injected per vertebral body, existence of intradiscal PMMA leakage, date and vertebral level(s) at which subsequent vertebral body fractures were diagnosed. A-P rateMaterials and methodsDiagnosisDiagnosis of nof new vertebral compression fracture ew verteb
7、ral compression fracture 1：plain radiography showed a definite decrease in the height of the vertebral body or MRI showed low signal intensity of bone marrow within the vertebral body on T-1 weighted images 2： in matched site of pain and tenderness.Materials and methods Fig. 1 Images of preoperative
8、 MRI scan in 72 year old female patient treated with percutaneous vertebroplasty at L2 and L3(left). This patient developednew symptomaticvertebral compression fracture at L1 after 28 months (right)SPSS analysis During the follow up period, 38 (15.6%) of the 244 patients returned for subsequent inte
9、rvention due to the development of newly developed symptomatic OVCFs Among them, five patients had new symptomatic compression fractures on follow up conventional radiography and were successfully managed by conservative care. The other thirty-three patients were subjected to repeated PVP.ResultsOn
10、univariate analysisThe location of new fracture(s) was adjacent to the previously treated vertebra(e) in 22 patients(58%) and remote in 16 patients (42%).There was no significant difference.T-test The effects of PVP on the risk of future fractures is not known. Thus, it is not clear if there is an i
11、ncreased risk associated with vertebroplasty. Nevertheless, PVP is suspected as a cause of repeated OVCFs and there are some possible postulations.Discussion In an experimental biomechanical study, Berlemann showed that the failure strength in compression of functional spine units (FSUs) treated by
12、augmentation of the caudal vertebra with PMMA is lower than that of untreated FSUs. They postulated that the increased stiffness of the augmented vertebrae alters the biomechanics of load transfer to the adjacent vertebrae. It may reflect altered biomechanics of the spine after PVP.postulate OR hypo
13、thesis Many other authors thought that the adjacent segment was more prone to be the site of new fractures. Berlemann report, 67% of the new lesion involved vertebrae adjacent to the previously treated vertebral level(s). But in our series, there was no significant difference between the location of
14、 new fracture(s) (adjacent to previously treated in 58% versus remote in 42%).About location Although the cause is unknown, one hypothesis is based on mechanical factors. It has been shown that augmentation of fractured vertebrae with cement can increase the overall stiffness of damaged segment. So
15、we can postulate that PVP not only alters the biomechanics of load transfer to the adjacent vertebrae, but also increases the stiffness of the whole FSUs or even throughout the thoracolumbar or lumbar spine. It is possible that the altered load transfer after PVP would not be limited to the adjacent
16、 vertebrae.About location : why In our study, the rate of developing new symptomatic OVCFs after PVP was correlated with the number of vertebral segment treated and inversely correlated with the degree of wedge deformation of treated vertebra(e). Augmentation of fractured vertebrae with cement can increase the ove
