title: Adjacent-level symptomatic fracture after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a retrospective analysis.
abstract: BACKGROUND
  Vertebral augmentation is an effective and minimally invasive procedure that is used extensively worldwide for the treatment of osteoporosis vertebral compression fractures (OVCFs). New pain from adjacent vertebra fracture (AVF) after initial cement augmentation has gradually been given attention, but the exact causes of AVF are still controversial. The purpose of this study was to analyze the associated incidence, risk factors, and possible causative mechanism of symptomatic AVF, and to evaluate the intrinsic relationship between cement leakage into the disk and AVF.
  
  
  METHODS
  Three hundred and fifty-eight patients (271 women, 87 men; mean age 70.5 ± 9.1 years; range 42-91 years) undergoing vertebral augmentation for their single level of OVCFs were enrolled in the study. Patients were divided into AVF (n = 26) and AVF-free (n = 332) groups, and the groups were compared with respect to preoperative and perioperative parameters, as well as postoperative results. Potential risk factors were evaluated using logistic regression analysis.
  
  
  RESULTS
  The rate of symptomatic AVF was 7.3%. The majority of symptomatic AVF, 57.7% of which developed 6 months after the procedures, were located mainly in the thoraco-lumbar vertebra. Significant differences were found between the AVF and AVF-free groups with regard to age, bone mineral density (BMD), and intravertebral clefts (p < 0.05). AVF occurred in six of 28 patients with intravertebral clefts, and five of them developed AVF within 6 months after the procedure. No statistically significant association was observed in the correlation between intradiscal cement leakage and the incidence of symptomatic AVF (p = 0.390).
  
  
  CONCLUSIONS
  Older age, lower BMD, and intravertebral clefts are the main risk factors for symptomatic AVF after vertebral augmentation, but intradiscal cement leakage does not increase the risk of AVF. AVF occurs because of the natural progression of osteoporosis. Even distribution of bone cement in the vertebral body is important in OVCF patients with intravertebral clefts.
authors.affiliation: Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, People's Republic of China, wangyttod@aliyun.com.
authors.forename: Yun-Tao
authors.initials: YT
authors.lastname: Wang
authors.forename: Xiao-Tao
authors.initials: XT
authors.lastname: Wu
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.forename: Zu-Bin
authors.initials: ZB
authors.lastname: Mao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D054854:Vertebroplasty / Q000009:adverse effects*