Percutaneous vertebroplasty for cephalad vertebral fractures after instrumented lumbar fusion.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To identify the effect of cement augmentation for cephalad vertebral fracture after instrumented lumbar fusion.

SUMMARY OF BACKGROUND DATA: Osteoporosis may contribute to cephalad vertebral fractures by an altered biomechanics in the adjacent segments due to the loss of motion at the fused segments. However, few studies on the treatment for cephalad fractures using bone cement augmentation after instrumented lumbar fusion have been published.

METHODS

Seventeen patients who had cephalad vertebral fractures after instrumented lumbar fusion underwent percutaneous vertebroplasty (PVP). All patients were divided into 2 groups according to the presence of intravertebral vacuum clefts (IVC) on plain radiographs and magnetic resonance imaging: group 1 consisted of 9 patients without an associated IVC and group 2 consisted of 8 patients with an IVC. The Oswestry Disability Index and the Visual Analogue Scale were recorded prospectively. The radiologic parameters of kyphotic deformity, vertebral height changes, and leakage of cement were studied.

RESULTS

The Oswestry Disability Index and Visual Analogue Scale scores in group 1 decreased after PVP, but the mean score in group 2 was higher than in group 1 at the last follow-up. The mean kyphosis measured 15.7±7.4 degrees preoperatively and 15.6±7.1 degrees at the final follow-up in group 1, and 16.9±8.8 degrees preoperatively and 27.2±8.8 degrees at the final follow-up in group 2.The mean preoperative anterior and posterior vertebral height ratio measured 0.6±0.2 preoperatively and 0.6±0.2 at the final follow-up in group 1, and 0.6±0.2 preoperatively and 0.5±0.2 at the final follow-up in group 2.The mean preoperative middle and posterior vertebral height ratio measured 0.5±0.1 preoperatively and 0.6±0.1 at the final follow-up in group 1, and 0.5±0.1 preoperatively and 0.4±0.2 at the final follow-up in group 2. Four patients underwent revision surgery in group 2 and 1 in group 1.

CONCLUSIONS

Although PVP treatment may be a useful method for cephalad vertebral fractures after instrumented lumbar fusion in elderly patients with persistent unremitting back pain, recollapse of the vertebral body can occur after a PVP for cephalad or adjacent vertebral fractures with an IVC.