The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

  • Choi, Sang Sik (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital) ;
  • Hur, Won Seok (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital) ;
  • Lee, Jae Jin (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital) ;
  • Oh, Seok Kyeong (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital) ;
  • Lee, Mi Kyoung (Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital)
  • Received : 2012.09.25
  • Accepted : 2012.10.19
  • Published : 2013.01.01
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Abstract

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the $1^{st}$ and $4^{th}$ (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

Keywords

References

  1. Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992; 13 Suppl 2: S27-31. https://doi.org/10.1016/8756-3282(92)90193-Z
  2. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 1999; 26: 2222-8.
  3. Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976) 2000; 25: 923-8. https://doi.org/10.1097/00007632-200004150-00005
  4. Choi Y, Han HC, Lim KJ. Pulmonary embolism after percutaneous vertebroplasty with polymethylmethacrylate: a case report. J Korean Pain Soc 2002; 15: 190-3.
  5. Kim DH, Kim KH, Kim YC. Minimally invasive percutaneous spinal techniques. Pennsylvania, Elsevier. 2011, pp 259-76.
  6. Lin WC, Lee YC, Lee CH, Kuo YL, Cheng YF, Lui CC, et al. Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis. Eur Spine J 2008; 17: 592-9. https://doi.org/10.1007/s00586-007-0564-y
  7. Lin CC, Shen WC, Lo YC, Liu YJ, Yu TC, Chen IH, et al. Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol 2010; 194: 1323-9. https://doi.org/10.2214/AJR.09.3287
  8. Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976) 2001; 26: 1537-41. https://doi.org/10.1097/00007632-200107150-00007
  9. Luo J, Daines L, Charalambous A, Adams MA, Annesley- Williams DJ, Dolan P. Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976) 2009; 34: 2865-73. https://doi.org/10.1097/BRS.0b013e3181b4ea1e
  10. Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2006; 27: 1933-7.
  11. Al-Ali F, Barrow T, Luke K. Vertebroplasty: what is important and what is not. AJNR Am J Neuroradiol 2009; 30: 1835-9. https://doi.org/10.3174/ajnr.A1732
  12. Han IH, Chin DK, Kuh SU, Kim KS, Jin BH, Yoon YS, et al. Magnetic resonance imaging findings of subsequent fractures after vertebroplasty. Neurosurgery 2009; 64: 740-4. https://doi.org/10.1227/01.NEU.0000339120.41053.F1
  13. He SC, Teng GJ, Deng G, Fang W, Guo JH, Zhu GY, et al. Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 2008; 33: 640-7. https://doi.org/10.1097/BRS.0b013e318166955f
  14. Kim DJ, Kim TW, Park KH, Chi MP, Kim JO. The proper volume and distribution of cement augmentation on percutaneous vertebroplasty. J Korean Neurosurg Soc 2010; 48: 125-8. https://doi.org/10.3340/jkns.2010.48.2.125

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