Repeat Percutaneous Vertebroplasty for Recurrent Pain Arising from Previously Treated Vertebrae in Patients with Osteoporotic Vertebral Compression Fractures

Study Design: A retrospective study. Summary of Background Data: Percutaneous vertebroplasty (PV) changes mechanical stress of vertebral column and can cause recurrent pain at the treated level. However, there were a few reports on the therapeutic effects of the repeat PV for patients with recurrent pain at the treated level. Objective: To evaluate the therapeutic effects of repeat PV at previously treated vertebral level for patients with osteoporotic vertebral compression fractures (OVCFs) having recurrent pain after initial PV. Methods: Institutional review board approval was obtained for this retrospective study. Patients with OVCFs who underwent repeat PV for recurrent pain at previously treated vertebral levels were identified and included in this study. Correlative parameters were analyzed that included pain score before and after repeat PV, amount of bone cement injected, and presence of cleft sign in the vertebral body on pre-PV and post-PV medical imaging tests. Results: Nine of consecutive 827 patients met the selection criteria. Cleft sign was identified in 5 patients before or during initial PV, whereas it was present in all 9 patients on prerepeat PV images. A reduction of 4.3±0.5 points of pain scale and 2.1±0.6 points of mobility rate at 1 week after the repeat PV was reported in all 9 patients. The mean pain scale and mobility rate score were 2.8±0.45 points and 0.3±0.5 at the 3-month follow-up, respectively. The mean volume of injected cement (6.8±1.92 mL) in repeat PV was larger than that in initial PV (4.2±0.84 mL). There was statistically significant difference (P=0.033). Conclusions: Repeat PV is an effective option for patients having OVCFs with recurrent pain at the previously treated level. There was a correlation between therapeutic benefits of repeat PV and the cleft sign disappearance in patients at the previously treated vertebral level.