title: Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incidence and risk factors associated with adjacent vertebral fracture after percutaneous vertebroplasty (PVP) to treat osteoporotic vertebral compression fractures. We also investigated the effect of intradiscal cement leakage on adjacent vertebral fracture formation after PVP.
  
  
  METHODS
  From January 2003 to March 2009, 188 patients (163 women, 25 men; mean age, 70.9 years; range, 42-92 years) who underwent 214 PVP sessions at 351 levels for osteoporotic vertebral compression fractures were retrospectively enrolled in this study. The effect of intradiscal cement leakage on new adjacent vertebral fracture formation after PVP was evaluated. Possible other risk factors were also analyzed using univariate and multivariate methods. The risk factors included age, gender, mean bone mineral density (BMD), the vertebral level treated, presence of an intravertebral cleft or cyst before treatment, kyphosis angle, wedge angle, and the injected cement volumes.
  
  
  RESULTS
  During the follow-up periods, new adjacent vertebral fractures developed in 36 (10.3%) of 351 treated levels. For 91 (25.9%) levels, intradiscal cement leakage was detected on procedural fluoroscopic radiographs. There was no statistically significant association between intradiscal cement leakage and new adjacent vertebral compression fracture (p = 0.789). Among the other risk factors, only the vertebral levels treated, especially the thoracolumbar junction, showed a significant relationship to new adjacent vertebral fractures (univariate analysis, p = 0.037; multivariate analysis, p = 0.043).
  
  
  CONCLUSIONS
  Intradiscal cement leakage does not seem to be related to subsequent adjacent vertebral compression fracture in patients who underwent PVP for treatment of an osteoporotic compression fracture. The thoracolumbar location of the initial compression fracture is the only factor correlated with an adjacent vertebral fracture after PVP.
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 97, Gurodong-Gil, Guro-Gu, Seoul 152-703, Korea.
authors.forename: Kyung-Ah
authors.initials: KA
authors.lastname: Lee
authors.forename: Suk-Joo
authors.initials: SJ
authors.lastname: Hong
authors.forename: Seunghun
authors.initials: S
authors.lastname: Lee
authors.forename: In Ho
authors.initials: IH
authors.lastname: Cha
authors.forename: Baek-Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D054854:Vertebroplasty / Q000009:adverse effects*
chemical_list: D001843:Bone Cements