Causes of Late Revision Surgery after Bone Cement Augmentation in Osteoporotic Vertebral Compression Fractures

Study Design: A retrospective study. Purpose: To elucidate the causes of late revision following bone cement augmentation for osteoporotic vertebral compression fractures (OVCFs). Overview of Literature: Percutaneous vertebroplasty (PVP) or kyphoplasty (KP) is thought to be effective for the treatment of OVCFs. Many complications related to PVP or KP have been reported. However, there is a paucity of reports regarding the causes of late revision surgery after failed PVP or KP. Methods: Twenty six patients who developed unremitted back pain and/or progressive neurological deficit after a symptom-free period since treatment with PVP or KP were enrolled. All patients underwent cement removal and anterior reconstruction. Among the 26 patients, 22 patients underwent anterior interbody fusion combined with posterior instrumentation; 4 patients underwent anterior reconstruction only. The causes of revision surgery were assessed. Clinical results were assessed using a visual analogue scale (VAS) and Oswestry Disability Index (ODI). The complications were analyzed. Results: The average time to revision surgery was 18.9 +/- 14.6 months (range, 3-78 months). The causes of late revision surgery included 6 late infections, 8 progressive kyphoses, 10 proximal fractures after instrumented lumbar fusions, and 2 late neurological involvement. During the mean follow-up period of 13.5 +/- 7.8 months, pre-revision mean VAS (8.5 +/- 0.9) and ODI (81.2 +/- 12.5) were improved to 4.2 +/- 1.4 and 54.8 +/- 17.6, respectively. Five patients (19%) had serious complications after revision surgery. Conclusions: This study presents complications of PVP or KP in the treatment of OVCFs although PVP or KP can be an effective treatment strategy for OVCF when applied in highly selected patients.