Therapeutic efficacy of vertebroplasty in osteoporotic vertebral compression fractures with avascular osteonecrosis: a minimum 2-year follow-up study.
METHODS
A retrospective review of clinical and radiological parameters.


OBJECTIVE
To assess for at least 2 years the radiological and clinical outcomes of patients who underwent polymethylmethacrylate (PMMA) vertebroplasty to treat osteoporotic vertebral compression fractures with avascular necrosis.


BACKGROUND
Recently, osteoporotic vertebral compression fractures with avascular osteonecrosis have been treated with percutaneous vertebroplasty. However, there have been no previous multiyear, clinical, and radiological studies of the results of vertebroplasty in the vertebral body with noninfected avascular osteonecrosis.


METHODS
Thirty patients were followed for at least 2 years after vertebroplasty. We retrospectively reviewed several parameters, including visual analogue scale score, Oswestry Disability Index, compression ratio, kyphotic angle, injection pattern of PMMA (interdigitation and solid mass), and morphological changes of the PMMA-cemented vertebral bodies. RESULTS.: The vertebral height and kyphotic angle were significantly corrected after vertebroplasty. However, the restored vertebral height recollapsed (P < 0.05), and the kyphotic angle became aggravated (P < 0.05) during the 2 years or longer of postoperative follow-up. Visual analogue scale and Oswestry Disability Index were significantly decreased at postoperative day 1. However, visual analogue scale and Oswestry Disability Index were significantly increased at 24 months postoperatively. There were 4 kinds of morphological changes of the injected PMMA-cemented vertebral body, including heterotopic ossification, fusion with the adjacent vertebral body, bone cement fragmentation and migration, and development of a radiolucent line around the PMMA mass in the vertebral body.


CONCLUSIONS
After vertebroplasty, the compression and kyphosis of avascular necrotic vertebral bodies progressed continuously for 2 years or longer. Vertebroplasty may not provide sufficient stability. Therefore, we strongly recommend that strict observation and follow-up be used after vertebroplasty.
Department of Neurosurgery, Spine Center, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
Dong Hwa
DH
Heo
Jong Hun
JH
Choi
Moon Kyu
MK
Kim
Hyeun Chul
HC
Choi
Je Hoon
JH
Jeong
Dong Kyu
DK
Chin
Yong Jun
YJ
Cho
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D019904:Polymethyl Methacrylate; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty
D001843:Bone Cements; D019904:Polymethyl Methacrylate