Early Adjacent Vertebral Fractures after Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective cohort study.
Purpose: To evaluate the incidence and risk factors for early adjacent vertebral fractures following balloon kyphoplasty (KP).
Overview of Literature: KP is a safe and effective treatment for pain alleviation in patients with osteoporotic vertebral compression fractures (OVCF). However, some studies have reported that the risk of newly developed fractures increases at the adjacent vertebra after KP.
Methods: Total 123 consecutive patients with painful OVCF who underwent KP were enrolled from January 2009 to June 2016. Early adjacent vertebral fractures were defined as new fractures that had developed within 3 months after surgery. Sex, age, body mass index (BMI), bone mineral density (BMD), vertebral height, kyphotic angle, Visual Analog Scale score, cement amount, and leakage were evaluated as risk factors for adjacent vertebral fractures. Only cement leakage into the disc space was included in this study.
Results: Early adjacent vertebral fractures were identified in 20 (16.2%) of the 123 patients. The mean time to diagnosis of fractures was 1.7±0.7 months after KP. The average patient age was 78.0±0.7 years, average BMI was 23.06±3.83 kg/m2, and mean BMD was −3.61±1.22 g/m2. Cement leakage was present in 16 patients, and fractures developed in 11 (68.7%). In contrast, fractures developed in nine patients (8.2%) without cement leakage. There were no significant differences in terms of age, BMI, BMD, kyphotic angle, or vertebral body height ratio between the fracture and control groups.
Conclusions: Cement leakage into the disc increased the risk of early adjacent vertebral fractures after balloon KP.

참고문헌 (Reference)

1 Lin EP, "Vertebroplasty : cement leakage into the disc increases the risk of new fracture of adjacent vertebral body" 25 : 175-180, 2004

2 Greene DL, "The eggshell technique for prevention of cement leakage during kyphoplasty" 20 : 229-232, 2007

3 Dong Joon Kim, "The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty" 대한신경외과학회 48 (48): 125-128, 2010

4 Zhong BY, "Risk prediction of new adjacent vertebral fractures after PVP for patients with vertebral compression fractures : development of a prediction model" 40 : 277-284, 2017

5 Grafe IA, "Reduction of pain and fracture incidence after kyphoplasty : 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis" 16 : 2005-2012, 2005

6 Harrop JS, "Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty" 29 : 2120-2125, 2004

7 Ensrud KE, "Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group" 48 : 241-249, 2000

8 Frankel BM, "Percutaneous vertebral augmentation : an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty" 7 : 575-582, 2007

9 Lo YP, "New vertebral fracture after vertebroplasty" 65 : 1439-1445, 2008

10 Garfin SR, "New technologies in spine : kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures" 26 : 1511-1515, 2001

11 Komp M, "Minimally-invasive therapy for functionally unstable osteoporotic vertebral fractures by means of kyphoplasty: prospective comparative study of 19 surgically and 17conservatively treated patients" 11 : 604-612, 2004

12 Baroud G, "Load shift of the intervertebral disc after a vertebroplasty : a finiteelement study" 12 : 421-426, 2003

13 Fribourg D, "Incidence of subsequent vertebral fracture after kyphoplasty" 29 : 2270-2276, 2004

14 Campbell PG, "Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty : a review of the literature" 1 : 61-64, 2008

15 Spross C, "Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures : analysis of the SWISSspine registry" 23 : 1332-1338, 2014

16 Bouza C, "Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures : a systematic review" 15 : 1050-1067, 2006

17 Borgstrom F, "Costs and quality of life associated with osteoporosis-related fractures in Sweden" 17 : 637-650, 2006

18 Robinson Y, "Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures : a prospective follow-up study in 102 consecutive patients" 2 : 2-, 2008

19 Lin J, "Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs : a retrospective study" 13 : 140-, 2018

20 Garfin SR, "Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients" 31 : 2213-2220, 2006

21 Johnell O, "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures" 17 : 1726-1733, 2006

22 Movrin I, "Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture : a comparison of balloon kyphoplasty and vertebroplasty" 130 : 1157-1166, 2010