Authors: M B Pitton S Herber C Bletz P Drees N Morgen U Koch B Böhm A Eckardt C Düber
Publish Date: 2007/07/19
Volume: 18, Issue: 1, Pages: 43-50
Abstract
The purpose of this study was to analyse the number and types of secondary fractures and to investigate the impact of intradiscal cement leaks for adjacent vertebral fractures Patients with osteoporotic vertebral fractures were treated with vertebroplasty Results were documented and prospectively followed by means of computed tomography CT and magnetic resonance imaging The frequency and the types of cement leakages were analysed from multiplanar CT images and secondary fractures were characterised as follows 1 adjacent fracture in the immediate vicinity of an augmented vertebra 2 sandwich fracture fracture of an untreated vertebra between two vertebrae that had been previously augmented and 3 distant fractures not in the vicinity of augmented vertebrae A total of 385 osteoporotic vertebral fractures were treated in 191 patients 61 men 130 women age 707 ± 97 years The overall rate of cement leaks was 556 including all leaks detectable by CT Intradiscal leaks through the upper the lower and both endplates occurred in 182 68 and 26 respectively In 39 patients 204 a total of 72 secondary fractures occurred 30 adjacent fractures in 23 patients 120 with a time to fracture of 2 months median 10/40 months first/third quartile Q1/Q3 11 secondary sandwich fractures in 11 patients 58 after 15 months median 025/75 months Q1/Q3 and 31 distant fractures in 20 patients 105 after 5 months median 20/80 months Q1/Q3 Ten of 30 adjacent fractures occurred in the presence of preexisting intradiscal cement leaks and 20 where there was no leakage Six of 11 sandwich fractures occurred in the presence of intradiscal leaks five leaks in both adjacent disc spaces one leak in the lower disc space and five where there was no leakage The rate of secondary adjacent and nonadjacent fractures is quite similar and there is no specific impact of intradiscal leakages on the occurrence of adjacent secondary fractures Adjacent fractures occur sooner than distant secondary fractures Sandwich fractures are associated with specific biomechanical conditions with a 379 fracture rate in sandwich constellations
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