• Chang-Chen Yang, Jui-Teng Chien, Tzung-Yi Tsai, Kuang-Ting Yeh, Ru-Ping Lee, and Wen-Tien Wu.
• Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
• Pain Physician. 2018 Sep 1; 21 (5): E483-E491.

BackgroundPercutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the development of adjacent vertebral fractures (AVF) has rarely been discussed.ObjectiveThis study aimed to compare the incidence of AVF among patients who received early PVP (= 30 days after symptom onset, EPVP) or late PVP (> 30 days after symptom onset, LPVP) in the thoracolumbar region (T10 to L2) after a 1-year follow up.Study DesignA retrospective cohort study.SettingDepartment of Orthopedic, an affiliated hospital of a medical university.MethodsPatients who had single-level, T-score = -2.5 of lumbar bone mineral density (BMD), primary OVCF in the thoracolumbar region (T10 to L2) and who received PVP between July 2012 and June 2014 were included in the study. They were divided into early PVP and late PVP groups according to the interval between symptom onset and treatment. The risk factors associated with subsequent AVFs were analyzed.ResultsOf the 225 patients reviewed, 124 met the criteria and were followed for a minimum of 1 year. Eleven patients (14.1%) in the EPVP group (n = 78) and 18 patients (39.1%) in the LPVP group (n = 46) experienced an AVF during the first year following vertebroplasty. Outcomes were significantly better in patients with higher bone mineral density, lower cement volume, and without cement leakage (P < 0.01). Cox regression indicated an increase risk for AVF for LPVP, with an adjusted hazard ratio of 6.08 (95% confidence interval: 2.50-14.81).LimitationThe incidence of AVFs could be over estimated due to this being a retrospective study with a small case number and lack of either biomechanical study of intra-vertebral cement distribution by times to support the result.ConclusionsCompared with later interventions, PVP performed within 30 days after fracture development may be associated with a lower risk of adjacent fractures in the thoracolumbar region.Key WordsPercutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression fracture, adjacent vertebral fracture.

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