Vertebroplasty In Nonfractured Vertebrae

Cement infusion into nonfractured vertebrae has been considered in at least three scenarios. Vertebroplasty of adjacent levels may be performed prior to surgical reconstruction of acute kyphotic angulations resulting from vertebra plana. In these cases, the surgeon requests infusion of cement into noninvolved vertebra above and below the fractured level for placement of orthopedic hardware. Biomechanical testing has determined that the cement provides a more robust substrate for placement of pedicle screws and other fixation devices (28). In these few cases, outcomes have been favorable but there are no data to support the widespread practice of vertebroplasty.

Second, vertebroplasty of unaffected levels in patients with significant kyphosis due to thoracic compression fractures has been suggested (24). The rationale in these cases is that further kyphotic deformity will lead to respiratory difficulty; however, no data are forthcoming. The authors have not performed vertebroplasty for this indication.

The last scenario is vertebroplasty of nonfractured vertebrae adjacent to a fractured level ("prophylactic" vertebroplasty). Experimental data suggest that treatment of one vertebra with cement infusion may place adjacent vertebrae at increased risk of spontaneous fracture, given decreased compliance of the local spinal segment (29). One clinical study (20) showed a small but statistically significant increased risk of vertebral fracture in the vicinity of a cemented level, although "vicinity" was not defined, and may not necessarily have been adjacent. Indeed, it remains common for patients treated with vertebroplasty to return with new fractures. The authors note that approx 17% of patients develop new fractures following vertebroplasty, at variable locations in relation to the treated level (unpublished data). These new-onset fractures may be unrelated to the vertebroplasty, as approx 20% of osteoporotic patients who suffer from one fracture and are treated conservatively will present with a new fracture within 1 yr (30). Furthermore, one cannot reliably determine whether an adjacent level or a remote level will be the site of the next compression fracture. Without further data, prophylactic vertebroplasty cannot be supported at this time.

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