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Review article
peer-reviewed

Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra



Abstract

It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.



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Review article
peer-reviewed

Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra


Author Information

Robert E. Jacobson Corresponding Author

Miami Neurosurgical Center, University of Miami Hospital

Ovidiu Palea

Anesthesiology and Pain Management, Provita Hospital

Michelle Granville

Miami neurosurgcial Institute, University of Miami Hospital, Coral Gables Surgical Center


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Review article
peer-reviewed

Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra


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Review article
peer-reviewed

Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra

Robert E. Jacobson">Robert E. Jacobson , Ovidiu Palea">Ovidiu Palea, Michelle Granville">Michelle Granville

  • Author Information
    Robert E. Jacobson Corresponding Author

    Miami Neurosurgical Center, University of Miami Hospital

    Ovidiu Palea

    Anesthesiology and Pain Management, Provita Hospital

    Michelle Granville

    Miami neurosurgcial Institute, University of Miami Hospital, Coral Gables Surgical Center


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: October 16, 2017

    DOI

    10.7759/cureus.1776

    Cite this article as:

    Jacobson R E, Palea O, Granville M (October 16, 2017) Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra. Cureus 9(10): e1776. doi:10.7759/cureus.1776

    Publication history

    Received by Cureus: September 24, 2017
    Peer review began: October 05, 2017
    Peer review concluded: October 09, 2017
    Published: October 16, 2017

    Copyright

    © Copyright 2017
    Jacobson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.



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Robert E. Jacobson, M.D.

Miami Neurosurgical Center, University of Miami Hospital

For correspondence:
bmjacobs@bellsouth.net

Ovidiu Palea

Anesthesiology and Pain Management, Provita Hospital

Michelle Granville

Miami neurosurgcial Institute, University of Miami Hospital, Coral Gables Surgical Center

Robert E. Jacobson, M.D.

Miami Neurosurgical Center, University of Miami Hospital

For correspondence:
bmjacobs@bellsouth.net

Ovidiu Palea

Anesthesiology and Pain Management, Provita Hospital

Michelle Granville

Miami neurosurgcial Institute, University of Miami Hospital, Coral Gables Surgical Center