Fig4: Lateral plain films of a 77-year-old man with an L1 compression fracture. a Immediate postoperative lateral plain X-ray. b Twelve months after the vertebroplasty, recollapse occurred and the injected CaP was partially reabsorbed. c Twenty-seven months after the vertebroplasty, he presented with back pain after a fall. Lateral plain X-ray showed that the CaP-augmented L1 vertebral body was more compressed than the immediately postoperative and follow-up X-rays, and the solid hump of the CaP cement was fractured as well (arrow)

Heo HD, Cho YJ, Sheen SH, Kuh SU, Cho SM, Oh SM - Osteoporos Int (2009)

Bottom Line: The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodies.Fourteen patients have been followed for more than 2 years after vertebroplasty.The compression of the CaP-augmented vertebrae progressed continuously for 2 years or more.The findings of this study suggest that vertebroplasty using CaP cement should be reconsidered.

Affiliation: Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 153 Kyo-dong, Chuncheon, Kangwon-do, South Korea.

Abstract: This study was undertaken to investigate the radiologic and clinical outcomes of vertebroplasty with calcium phosphate (CaP) cement in patients with osteoporotic vertebral compression fractures. The morphological changes of injected CaP cement in osteoporotic compressed vertebral bodies were variable and unpredictable. We suggest that the practice of vertebroplasty using CaP should be reconsidered.Recently, CaP, an osteoconductive filler material, has been used in the treatment of osteoporotic compression fractures. However, the clinical results of CaP-cement-augmented vertebrae are still not well established. The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodies.Fourteen patients have been followed for more than 2 years after vertebroplasty. The following parameters were reviewed: age, sex, T score, compliance with osteoporosis medications, visual analog scale score, compression ratio, subsequent compression fractures, and any morphological changes in the filler material.The morphological changes of injected CaP included reabsorption, condensation, bone formation (osteogenesis), fracture of the CaP solid hump, and heterotopic ossification. Out of 14 patients, 11 (78.6%) developed progression of the compression of the CaP-augmented vertebral bodies after vertebroplasty.The morphological changes of the injected CaP cement in the vertebral bodies were variable and unpredictable. The compression of the CaP-augmented vertebrae progressed continuously for 2 years or more. The findings of this study suggest that vertebroplasty using CaP cement should be reconsidered.