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Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra

It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid...

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Autores principales: Jacobson, Robert E, Palea, Ovidiu, Granville, Michelle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732011/
https://www.ncbi.nlm.nih.gov/pubmed/29255655
http://dx.doi.org/10.7759/cureus.1776
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author Jacobson, Robert E
Palea, Ovidiu
Granville, Michelle
author_facet Jacobson, Robert E
Palea, Ovidiu
Granville, Michelle
author_sort Jacobson, Robert E
collection PubMed
description It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.
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spelling pubmed-57320112017-12-18 Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra Jacobson, Robert E Palea, Ovidiu Granville, Michelle Cureus Orthopedics It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface. Cureus 2017-10-16 /pmc/articles/PMC5732011/ /pubmed/29255655 http://dx.doi.org/10.7759/cureus.1776 Text en Copyright © 2017, Jacobson et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Jacobson, Robert E
Palea, Ovidiu
Granville, Michelle
Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title_full Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title_fullStr Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title_full_unstemmed Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title_short Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra
title_sort progression of vertebral compression fractures after previous vertebral augmentation: technical reasons for recurrent fractures in a previously treated vertebra
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732011/
https://www.ncbi.nlm.nih.gov/pubmed/29255655
http://dx.doi.org/10.7759/cureus.1776
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