Impact of cement leakage into disks on the development of adjacent vertebral compression fractures

Study Design: A retrospective study assessing new adjacent vertebral compression fracture (VCF) after percutaneous vertebroplasty (PV). Objective: To evaluate the relationship between cement leakage into the disk during initial PV and development of subsequent new adjacent VCF. Summary of Background Data: Cement leakage outside the vertebral body during PV has been reported and usually responds to conservative treatment. Sometimes bone cement may leak into the intervertebral disk and result in painful new adjacent VCF that usually requires another PV for pain relief. Methods: From January 2002 to December 2002, a total of 106 consecutive patients underwent PVs for osteoporotic VCFs. The risk of new fractures of adjacent vertebral bodies, the amount of cement injection, and the duration of development of new adjacent fractures in relation to cement leakage into the disk were retrospectively assessed and statistically compared. Results: New adjacent VCFs occurred in 20 (18.9%) of 106 patients at 22 adjacent vertebral bodies after PVs during at least 24 months of follow-up. The difference in number of new adjacent fractures between both patients and vertebral bodies with cement leakage and those without leakage into the disk were statistically significant (P<0.001 and P<0.001). Amounts of cement injected and duration to development of new adjacent fractures differed between patients with or without cement leakage (P<0.001 and P=0.005, respectively). Conclusions: PV is a simple and effective, but not risk-free or complication-free procedure for the treatment of osteoporotic VCF. Patients undergoing PV should be informed of the possibility of new adjacent fractures and the higher risk if cement leaks into the disk.