2012년 10월 8일 월요일

Subsequent Vertebral Fracture After Vertebroplasty Incidence and Analysis of Risk Factors

Clinical Case Series
Spine 2012;37:179-183

Title:
Subsequent Vertebral Fracture After Vertebroplasty
Incidence and Analysis of Risk Factors


Authors
Yi-An Li
Che-Li Lin
Ming-Chau Chang
Chien-Lin Liu
Tain-Hsiung Chen
Shih-Chang Lai

Study Design.
A retrospective review and analysis of consecutive patients (single-level vertebroplasty) between March 2002 and March 2006

Objective.
1. Analyze the risk factors for subsequent fractures after vertebroplasty

2. Predict the postoperative fracture-free time and rate

3. Evaluate the effect of bone cement volume injected

Summary of Background Data.
1. Conflicting conclusions about risk factors on subsequent fractures after VP in previous studies.

2. Various frequency of refracture from 12~52%

3. Adjacent level-new fractures with different risk factors indentified

4. No data available on the effect of injected bone cement volume

5. No consensus had been reached as to the optimal cement volume.

Methods.
1. Single-level vertebroplasty and followed a standardized postoperative care protocol.

2. Variables: patient constitutional factors, radiographic parameters, bone cement volume

Results.
1. Total 166 patients (76 m/ 90 f), mean age/73.4 years

2. Mean F/U Period: 15.3 months

3. Overall refracture rate: 38% (mean fracture-free interval: 32 months)

4. Significant risk of subsequent adjacent fracture
 à Greater volume of bone cement & greater degree of vertebral height restored

5. No risk factor for subsequent remote fracture

6. Positive correlation between greater bone cement volume and deformity correction after vertebroplasty

Conclusion.
1. Most subsequent fractures occurred at the adjacent level within the first 3 months.

2. Patient preoperative condition did not help predict refracture.

3. Although a greater volume of bone cement injected when performing vertebroplasty contributed to the risk of subsequent adjacent fracture, it resulted in a greater improvement of kyphosis.

Vertebroplasty는 척추 성형술로서  골절된 척추체에 물질을 주입하여 형태를 보강해주는
수술입니다. 물질이라 함은 골 시멘트를 말하는 것이며 보통 2~4주정도 보존적 치료에도
통증 완화가 없거나 합병증의 가능성이 높은 노인 환자들, 악성종양에 의한 골 파괴로
심한 통증을 호소하는 환자들에게 시행되며, 전신마취가 아닌 국부마취로 시술이 가능하다.

본 논문의 결론을 짧게 얘기 하자면,
골 시맨트로 부러진 척추뼈를 보강해주면 그 위 아래 척추뼈에서 다시 골절이 발생할 수 도
있고 대부분의 골절은 Vertebroplasty시술 후 처음 3개월 안에 발생한다.
그리고 환자의 수술전 상태가 수술 후 재골절을 예측하는데 도움이 되지는 않는다는 결론
입니다.

현재 Vertebroplasty는 제가 알기로...미국에서 논란이 심하게 되는것 같습니다.
논란의 내용은...추후 업로드 하겠습니다.


"This comes from Spine (c) 2012 Lippincott Williams & Wilkins, Inc."