Objective: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness andthe strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect maycause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique toovercome this complication. The aim of this study is to retrospectively evaluate the clinical results of theelastoplasty procedure.Materials and methods: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinicallyevaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean agewas 67 (range 38e84) years. The mean follow up period was 12,5 months. The patients were evaluatedradiologically for the presence of adjacent level fractures postoperatively. Complications were recorded.Results: The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic siliconepulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. Therewas an adjacent level fracture in 1 case and another fracture which was not at the adjacent level inanother one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (
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1. Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166e168.
2. Heo DH, Chin DK, Yoon YS, Kuh SU. Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int. 2009;20(3):473e480.
3. Yoshii T, Ueki H, Kato T, Tomizawa S, Okawa A. Severe kyphotic deformity resulting from collapses of cemented and adjacent vertebrae following percutaneous vertebroplasty using calcium phosphate cement. A case report. Skelet Radiol. 2014;43(10):1477e1480.
4. Lin WC, Lee YC, Lee CH, et al. Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis. Eur Spine J. 2008;17(4): 592e599.
5. Harrop JS, Prpa B, Reinhardt MK, Lieberman I. Primary and secondary osteoporosis' incidence of subsequent vertebral compression fractures after kyphoplasty. Spine (Phila Pa 1976). 2004;29(19):2120e2125.
6. Han SL, Wan SL, Li QT, et al. Is vertebroplasty a risk factor for subsequent vertebral fracture, meta-analysis of published evidence? Osteoporos Int. 2015;26(1):113e122.
7. Trout AT, Kallmes DF. Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol. 2006;27(7):1397e1403.
8. Fahim DK, Sun K, Tawackoli W, et al. Premature adjacent vertebral fracture after vertebroplasty: a biomechanical study. Neurosurgery. 2011;69(3): 733e744.
9. Baroud G, Nemes J, Heini P, Steffen T. Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J. 2003;12(4):421e426.
10. Nagaraja S, Awada HK, Dreher ML. Vertebroplasty increases trabecular microfractures in elderly female cadaver spines. Osteoporos Int. 2015;26(7): 2029e2034.
11. Polikeit A, Nolte LP, Ferguson SJ. The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976). 2003;28(10):991e996.
12. Kim JM, Shin DA, Byun DH, Kim HS, Kim S, Kim HI. Effect of bone cement volume and stiffness on occurrences of adjacent vertebral fractures after vertebroplasty. J Korean Neurosurg Soc. 2012;52(5):435e440.
13. Schulte TL, Keiler A, Riechelmann F, Lange T, Schmoelz W. Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades. Eur Spine J. 2013;22(12):2695e2701.
14. Bornemann R, Rommelspacher Y, Jansen TR, Sander K, Wirtz DC, Pflugmacher R. Elastoplasty: a silicon polymer as a new filling material for kyphoplasty in comparison to PMMA. Pain Physician. 2016;19(6):E885eE892.
15. Urlings TA, van der Linden E. Elastoplasty: first experience in 12 patients. Cardiovasc Interv Radiol. 2013;36(2):479e483.
16. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45e56.
17. Blasco J, Martinez-Ferrer A, Macho J, et al. Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Min Res. 2012;27(5): 1159e1166.
18. Hierholzer J, Fuchs H, Westphalen K, Baumann C, Slotosch C, Schulz R. Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Interv Radiol. 2008;31(6):1178e1183.
19. Li YA, Lin CL, Chang MC, Liu CL, Chen TH, Lai SC. Subsequent vertebral fracture after vertebroplasty: incidence and analysis of risk factors. Spine (Phila Pa 1976). 2012;37(3):179e183.
20. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol. 2006;27(1): 217e223.
21. Tseng YY, Yang TC, Tu PH, Lo YL, Yang ST. Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty. Spine (Phila Pa 1976). 2009;34(18):1917e1922.
22. Fribourg D, Tang C, Sra P, Delamarter R, Bae H. Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976). 2004;29(20): 2270e2276. discussion 2277.
23. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976). 2001;26(14):1547e1554.
24. Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976). 2001;26(14):1537e1541.
25. Boger A, Heini P, Windolf M, Schneider E. Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement. Eur Spine J. 2007;16(12):2118e2125.
26. Kinzl M, Benneker LM, Boger A, Zysset PK, Pahr DH. The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty. Eur Spine J. 2012;21(5):920e929.
27. Kobayashi N, Numaguchi Y, Fuwa S, et al. Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty. Acad Radiol. 2009;16(2):136e143.
28. Chiang CK, Wang YH, Yang CY, Yang BD, Wang JL. Prophylactic vertebroplasty may reduce the risk of adjacent intact vertebra from fatigue injury: an ex vivo biomechanical study. Spine (Phila Pa 1976). 2009;34(4):356e364.
29. Yen CH, Teng MM, Yuan WH, Sun YC, Chang CY. Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2012;33(5): 826e832.
30. Aquarius R, Homminga J, Hosman AJ, Verdonschot N, Tanck E. Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: an in vitro cadaveric study. Med Eng Phys. 2014;36(7):944e948.
31. Nouda S, Tomita S, Kin A, Kawahara K, Kinoshita M. Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine. Spine (Phila Pa 1976). 2009;34(24):2613e2618.
32. Hulme PA, Krebs J, Ferguson SJ, Berlemann U. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976). 2006;31(17): 1983e2001.
33. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18(10):1897e1904.
34. Cortet B, Cotten A, Boutry N, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999;26(10):2222e2228.
35. Ploeg WT, Veldhuizen AG, The B, Sietsma MS. Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J. 2006;15(12):1749e1758.
36. Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg. 2002;96(1 Suppl):56e61.
37. Venmans A, Lohle PN, van Rooij WJ, Verhaar HJ, Mali WP. Frequency and outcome of pulmonary polymethylmethacrylate embolism during percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2008;29(10):1983e1985.