Repeat vertebroplasty for unrelieved pain at previously treated vertebral levels with osteoporotic vertebral compression fractures

Study Design. A retrospective study was performed in patients with a repeat percutaneous vertebroplasty ( PV) at the vertebral levels previously undergoing vertebroplasty. Objective. Our purpose of this study is to examine if a repeat PV is effective on pain-relief at the vertebral levels previously undergoing vertebroplasty. Summary of Background Data. Although pain-relief is usually high with the treatment of PV in the painful osteoporotic vertebral compression fractures, there are still about 5% to 22% of such patients experiencing no improvement on pain after PV. A repeat PV at the same vertebrae previously treated with PV may be an option for these patients without a pain-relief. Methods. Out of 334 procedures of PV in 242 patients with osteoporotic vertebral compression fractures from October 2000 to June 2006 in our institute, 15 vertebrae in 15 patients with unrelieved pain in 4 to 32 days after an initial PV were treated with a repeat vertebroplasty. The clinical outcomes were assessed by measurements of visual analog scale, and the imaging features were analyzed pre- and postprocedure. Results. The mean volume of Polymethylmethacrylate injected in each vertebra was 4.0 mL ( range, 1.5 - 9 mL) in the repeat PV. During the first month of follow-up after repeat PV in this series, a mean visual analog scale scores of the pain level was reduced from 8.6 ( range, 7 - 10) pre-procedure to 1.67 points ( range, 0 - 4) postprocedure, with a mean reduction of 6.93 points ( range, 4 - 8). Complete and partial pain relief were reached in 11 ( 73%) and 4 patients ( 27%), respectively in a mean follow-up of 15 months. No serious complications related to the procedures occurred, but asymptomatic Polymethylmethacrylate leakage around vertebrae was demonstrated on radiograph or computed tomography in 2 patients. Conclusion. The outcomes of this series suggest that repeat PV is effective at the same vertebral levels in patients without pain-relief who underwent previous PV. Absent or inadequate filling of cement in the unstable fractured areas of the vertebral body may be responsible for the unrelieved pain after the initial PV.