Clinical evaluation of repeat percutaneous vertebroplasty for symptomatic cemented vertebrae.
BACKGROUND
Percutaneous vertebroplasty (PV) with polymethylmethacrylate is widely used to treat osteoporotic vertebral compression fracture and satisfactory clinical outcomes have been reported in the literature. However, recurrent or persistent back pain after PV is not uncommon. Sometimes, the pain may result from pathogenesis within the previously treated vertebra. In this study, we evaluated the efficacy and safety of repeat PV for treating patients with recurrent back pain caused by the previously cemented vertebrae.


METHODS
We retrospectively reviewed the medical records of 18 patients who underwent repeat PV to treat symptomatic cemented vertebrae. Patients were categorized into 3 groups based on clinical presentation and imaging studies: those with refracture (RF), residual vacuum (RV), and osteonecrosis (ON) along the bone-cement interface. A bipedicle approach was used for repeat PV in all patients. The visual analogue scale (VAS) and modified Brodsky criteria were used to evaluate clinical outcomes before and after surgery. The Kruskal-Wallis test, Wilcoxon signed-rank test, and Spearman correlation analyses were used to analyze patient surgical prognosis and radiologic findings.


RESULTS
Nine patients were diagnosed with RF, 5 with RV, and 4 with ON. The average VAS score was 77.1 (range, 62-90) before repeat PV (80.1, 72.4, and 76.3 for the RF, RV, and ON groups, respectively) and 34.4 (range, 25-45) after repeat PV treatment (33.1, 36.8, and 34.3 for the RF, RV, and ON groups, respectively). The VAS score significantly decreased in all 3 groups. The vertebral body height was significantly restored by a mean of 13.9% across all groups (17.8%, 12.7%, and 6.8% in the RF, RV, and ON groups, respectively). Fifteen patients recovered from vertebral compression fracture and regained their preinjury activities of daily living. No surgery-related complications occurred except asymptomatic cement leakage in 5 patients.


CONCLUSIONS
The results of this research demonstrate that repeat PV may be an effective method for relieving recurrent or persistent pain in patients with symptomatic cemented vertebrae, allowing them to regain functional activity.
Department of Orthopaedic Surgery and Anesthesiology, E-Da Hospital, I-Shou University, Taiwan, ROC.
Yen-Chun
YC
Chiu
Shih-Chieh
SC
Yang
Hung-Shu
HS
Chen
Yu-Hsien
YH
Kao
Yuan-Kun
YK
Tu
Kao-Chi
KC
Chung
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology*; D001843:Bone Cements / Q000627:therapeutic use; D060826:Cementoplasty / Q000706:statistics & numerical data; D055111:Failed Back Surgery Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000453:epidemiology / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology*; D019904:Polymethyl Methacrylate; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion
D001843:Bone Cements; D019904:Polymethyl Methacrylate