title: Diagnosis of painful cemented vertebrae from failed vertebroplasty: modified dynamic radiographs play an important role.
abstract: The diagnosis of painful cemented vertebrae resulting from failed PV is not clearly defined in literature. This report evaluates the effectiveness of modified dynamic radiographs in diagnosing painful cemented vertebrae resulting from failed PV.
  
  
  
  From January 2011 to June 2015, 345 patients with a total of 399 VCFs underwent PV at our institution. Among the 345 patients, 27 patients underwent repeated PV at the cemented vertebrae because of persisting or recurrent pain after vertebroplasty. The prevertebroplasty examinations included routine radiographs, modified dynamic radiographs, and MRI. Kyphotic angles and the anterior vertebral body height (AVBH) were measured. The image findings in routine radiographs, modified dynamic radiographs, and MRI were compared. Finally, a visual analog scale was used to measure the outcome.
  
  
  
  The patients ranged in age from 67 to 90 years. MRI revealed a moderate amount of fluid (definite diagnosis of refracture) in the cemented vertebrae in seven patients, bone edema without fluid in nine patients, and bone edema with minimal fluid in ten patients. The rate of diagnosis of painful cemented vertebrae according to MRI was 27% (7/26). The difference in the kyphotic angle between sitting and supine cross-table lateral radiographs was -9.36° ± 5.20° (P < 0.001). The difference in AVBH was 8.08 ± 3.21 mm (P < 0.001). All 27 patients were confirmed to have dynamic mobility according to the modified dynamic radiographs.
  
  
  
  When the diagnosis of painful cemented vertebrae is questionable, modified dynamic radiographs can help diagnose painful cemented vertebrae resulting from failed PV.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. yenjenc.tw@yahoo.com.tw.|Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan. yenjenc.tw@yahoo.com.tw.|Department of Public Health, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. yenjenc.tw@yahoo.com.tw.|Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. yenjenc.tw@yahoo.com.tw.
authors.forename: Yen-Jen
authors.identifier: 0000-0001-6340-3200
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Radiology, Children's Hospital, China Medical University Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.|School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan.
authors.forename: Hsien-Te
authors.initials: HT
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, Tainan Municipal An-Nan Hospital, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan.
authors.forename: Ruey-Mo
authors.initials: RM
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.|School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan.
authors.forename: Horng-Chaung
authors.initials: HC
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D058866:Osteoporotic Fractures / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D017211:Treatment Failure; D054854:Vertebroplasty / Q000295:instrumentation
chemical_list: D001843:Bone Cements
keywords: Diagnosis; Modified dynamic radiographs; Recurrent pain; Refracture; Vertebral compression fractures; Vertebroplasty