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Vertebroplasty appears to increase the risk for new fractures in adjacent vertebrae

A study found that vertebroplasty, a procedure used to treat painful compression fractures in the spinal vertebrae due to osteoporosis, appears to increase the risk for new fractures in adjacent vertebrae.
The study also found vertebrae adjacent to fractures treated with vertebroplasty fracture significantly sooner than more distant vertebrae.

Findings are published in the American Journal of Neuroradiology.

" We found there is a relationship between vertebroplasty and the development of new fractures," says Andrew Trout, first author of the paper describing the study's findings. " People should be made aware of the fact that despite the positive benefits of vertebroplasty, there is a risk of new fractures with this procedure."

The researchers discovered that following vertebroplasty, which involves injecting bone cement into the vertebrae to stabilize fractures, patients' risk for new fractures in vertebrae adjacent to those treated was 4.62 times the risk for nonadjacent vertebral fractures.
In addition, they found that new fractures occurred in adjacent vertebrae sooner than in nonadjacent vertebrae: a median of 55 days following vertebroplasty for adjacent fractures and 127 days for nonadjacent vertebral fractures.

This is the largest study ever to address the risk of new fractures post-vertebroplasty and the first study to examine whether there is a difference in time course between the development of new fractures adjacent and nonadjacent to the original fracture after treatment with vertebroplasty.

" Previous studies of vertebroplasty in cadavers and using computer simulation suggested that inserting cement in one bone weakens adjacent bones," explains David Kallmes, Mayo Clinic neuroradiologist and senior study investigator.
The weakening effect is possible due to the overall cushioning effect of the spine, where stiffening one part puts greater stress on another, he says.

" Everyone involved in vertebroplasty research is concerned about the possibility that placement of cement into fractures will actually increase the risk of fractures in other bones nearby," says Kallmes. " Of course we do not want to cause new fractures by treating existing fractures, so we are studying treated patients to see if their bones are fracturing sooner or more frequently than would otherwise be expected."

Kallmes explains that though this study points to a significant association between vertebroplasty and new fractures occurring in adjacent vertebrae, it is not absolute proof of cause and effect.

" We consider the findings of the current study provocative," he says. " Our findings suggest vertebroplasty speeds -- and possibly facilitates -- the fracture of adjacent vertebrae. This is not definitive evidence, but should be considered when discussing risks with patients before embarking on vertebroplasty."

At this point in the research, Kallmes still practices vertebroplasty and believes the potential advantages outweigh the risks.

" I still have an open mind about the true risk of new fracture after vertebroplasty," he says. " Vertebroplasty most likely is a good procedure, and it is still probably prudent to help relieve pain with vertebroplasty. We need to be aware of potential long-term risks, however."

Kallmes recommends that patients considering vertebroplasty for unhealed vertebral fractures consider all potential risks with their physicians, including risks of new fractures in adjacent vertebrae, prior to undergoing the treatment.