A difficult question to answer is whether vertebroplasty increases the risk of collapse of adjacent vertebrae. There is no prospective randomized study in the literature comparing the incidence of new vertebral fractures in patients with osteoporotic VCs either treated with vertebroplasty or managed conservatively.
In a series of 177 osteoporotic patients treated with vertebroplasty and reviewed retrospectively after two years or more, 22 (12.4%) developed a total of 36 new vertebral body fractures (26). In another small series of 25 patients with osteoporosis who had a total of 34 levels treated with vertebroplasty, 13 (52%) developed at least one new vertebral fracture at an average follow-up of 48 months (range 12-84 months) (27). However, these figures should be compared to the natural history of osteoporotic VC. Lindsay et al. evaluated the risk of new vertebral fractures within one year following a vertebral fracture in patients with osteoporosis enrolled in four large three-year prospective clinical trials (28); they found an incidence of 19.2% new vertebral fractures in the year following the fracture (21). Therefore, there is no evidence that the overall incidence of new vertebral fractures is increased following vertebroplasty.
However, more precisely, the incidence of new vertebral fractures in adjacent vertebrae may be increased by vertebroplasty, which increases stiffness in the vertebral segment. Grados et al. found that the relative risk of fracture of a vertebral segment adjacent to a treated vertebral body was 2.27 (27). Sixty-seven percent of the new VCs involved vertebrae adjacent to the previously treated vertebral level in the study by Uppin et al. and interestingly, 67% of the new vertebral fractures occurred within 30 days after treatment of the initial fracture (26).
However, nothing can be considered as established concerning the increased risk of collapse of adjacent vertebrae since it has been postulated that bone loss may occur in vertebral bodies adjacent to an original fracture (29) and it is a common observation that osteoporotic VC involve several adjacent vertebrae in a short period of time. Therefore, prospective randomized studies are needed to resolve this issue.
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