Analysis of risk factors of subsequent fractures after vertebroplasty

Purpose The purpose of this study is to identify risk factors related to the development of subsequent fractures after vertebroplasty. Method A retrospective study was conducted to review 175 patients with a 1-year follow-up who underwent vertebroplasty for first-time and single-level osteoporotic vertebral fractures. Subsequent fractures were diagnosed as recurrent intractable back pain, post-operatively correlated with MR image. Clinical parameters, such as age, gender, baseline VAS-score, lumbar bone mineral density (BMD) T -score, history of use of steroids, bisphosphonate therapy, symptom-free interval, the amount of bone cement injected, vacuum clefts, leakage of cement into the disk space, treated level and the changes of spinal geometry were recorded. Results During the follow-up period, subsequent fractures developed in 37 (21.1 %) of 175 patients. Significant differences ( P < 0.05) were found between the patients with subsequent fractures and the patients without subsequent fractures in regard to their BMD T -score, and treated vertebrae location. Average BMD T -score was −3.4 ± 1.5 in patients with subsequent fractures and −2.9 ± 1.6 in patients without subsequent fractures. The percentage of subsequent fractures was 13.9 % (10 of 72) for treated vertebrae located in non-thoracolumbar junction, and 26.2 % (27 of 103) in the thoracolumbar junction. Conclusion The most important risk factors affecting subsequent fractures after vertebroplasty were osteoporosis and treated level at the thoracolumbar junction.