Risk of post-vertebroplasty fracture in adjacent vertebral bodies appears correlated with the morphologic extent of bone cement

Background: New fractures in adjacent vertebral bodies were found after percutaneous vertebroplasty. We evaluated the correlation between extent of polymethylmethacrylate cement and occurrence of post-vertebroplasty fractures in patients with osteoporosis. Methods: Totally 162 adjacent vertebral bodies with no fracture at the time of vertebroplasty and the distribution of cement in corresponding treated vertebral bodies of 98 patients were included for the evaluation. Length of follow-up after vertebroplasty was 734 ± 314 days (range, 366–1838 days). Based on proximity of bone cement to the adjacent vertebral body, cement extent was classified as disc level (the closest), endplate level, or trabecula level (the farthest). Results: Forty-one adjacent vertebrae had post-vertebroplasty fracture occurring 2–1038 days after vertebroplasty. The percentages of adjacent vertebral bodies having post-vertebroplasty fracture about cement extent were: disc level, 44; endplate level, 29; and trabecula level, 7. Conclusion: Our study revealed that the risk of subsequent fracture in the adjacent vertebral bodies was correlated with the extent of bone cement after vertebroplasty. Preventive measures can be taken from this observation to reduce the percentage of post-vertebroplasty fracture in adjacent vertebral bodies