경피적 척추성형술 후 추가 골절발생의 임상적 분석

Abstract

Objective: This study aims to investigate the incidence and risk factors of subsequent vertebral fracture after percutaneous vertebroplasty (PV) with polymethylmethacrylate (PMMA) in patients with osteoporotic vertebral compression fractures (OVCF). Methods: This study retrospectively reviewed 188 patients (148 women and 40 men) who underwent PV for the treatment of OVCF at a single institute between March 2005 and January 2011. Patients who returned with new fracture after initial successful PV were evaluated by repeat MR imaging. This study analyzed the incidence and risk factors of subsequent vertebral fracture, including BMI, Bone mineral density(BMD), presence of diabetes, smoking, use of bisphosphonates, cement volume, cement leakage into the disc. Data were also analyzed according to level of fracture, adjacent fracture or non-adjacent fracture, and we compared the risk factors. Results: Among 188 patients treated with PV, 32 patients (17%) experienced newly developed vertebral fractures during the follow-up period (28.84±11.92 months on the average). 32 subsequent vertebral fractures were 17 adjacent level vertebral fractures and 15 non-adjacent level vertebral fractures. Subsequent vertebral fractures at the lumbar level (53.1%) were more frequent than those at thoracic level (46.9%). Smoking, diabetes mellitus, amount of PMMA, and bisphosphonate use did not correlate with the risk of subsequent fracture. BMD, BMI and intradiscal leakage of PMMA were the significant risk factors. Conclusion: The subsequent vertebral fracture should be considered before PVA with PMMA. The cement leakage into the disc, low BMI and low BMD could increase the risk of subsequent fracture.