Skip to main content

Advertisement

Log in

Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty

  • Osteoporotic Fracture Management
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

It is still controversial whether adjacent level compression fractures after balloon kyphoplasty (BK) and vertebroplasty (VP) should be regarded as the consequence of stiffness achieved by augmentation with bone cement or if the adjacent level fractures are simply the result of the natural progression of osteoporosis. The purpose of this study was to evaluate the adjacent level fracture risk after BK as compared with VP and to determine the possible dominant risk factor associated with new compression fractures.

Materials and methods

73 consecutive patients with painful vertebral compression fractures (VCFs) were enrolled in a prospective nonrandomized study. BK was performed in 46 patients (51 vertebral bodies) and VP in 27 patients (32 vertebral bodies). The first patient’s visit was before the operative procedure, when clinical and radiographical examinations were done. The follow-up visits, considered in the analysis, were on the first day and after 1 year, postoperatively.

Results

In 1 year, 3 out of 46 patients (6.5%) treated with BK, and 2 out of 27 patients (7.4%) treated with VP sustained adjacent level fracture. More patients with a BMD higher or equal to 3.0 experienced a new fracture than those with a BMD less than 3.0 (odds ratio = 13.00; 95% confidence interval: 1.35–124.81), and the risk for adjacent level fractures decreased significantly when the postoperative kyphotic angle was less than 9° compared with that of higher or equal to 9° (odds ratio = 12.00; 95% confidence interval: 1.25–114.88).

Conclusion

Our results indicate that BK and VP are methods with a low risk of adjacent level fractures. The most important factors for new VCFs after a percutaneous augmentation procedure are the degree of osteoporosis and altered biomechanics in the treated area of the spine due to resistant kyphosis. These results suggest that the adjacent vertebrae would fracture eventually, even without the procedure. BK and VP offer a comparable rate of pain relief.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aebli N et al (2002) Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep. Spine (Phila Pa 1976) 27(5):460–466

    Google Scholar 

  2. Ananthakrishnan D et al (2005) The effect on anterior column loading due to different vertebral augmentation techniques. Clin Biomech (Bristol, Avon) 20(1):25–31

    Article  Google Scholar 

  3. Assessment of fracture risk, its application to screening for postmenopausal osteoporosis (1994) Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129

    Google Scholar 

  4. Barr JD et al (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976) 25(8):923–928

    CAS  Google Scholar 

  5. Belkoff SM et al (2001) An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine (Phila Pa 1976) 26(2):151–156

    CAS  Google Scholar 

  6. Berlemann U et al (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84(5):748–752

    Article  CAS  PubMed  Google Scholar 

  7. Briggs AM et al (2006) The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo. Eur Spine J 15(12):1785–1795

    Article  PubMed  Google Scholar 

  8. Cook DJ et al (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36(6):750–756

    Article  CAS  PubMed  Google Scholar 

  9. Deramond H et al (1997) Percutaneous vertebroplasty. Semin Musculoskelet Radiol 1(2):285–296

    Article  PubMed  Google Scholar 

  10. Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114(4):257–265

    Article  PubMed  Google Scholar 

  11. Fribourg D et al (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976) 29(20):2270–2276 (discussion 2277)

    Google Scholar 

  12. Galibert P et al (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33(2):166–168

    CAS  PubMed  Google Scholar 

  13. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976) 26(14):1511–1515

    CAS  Google Scholar 

  14. Genant HK et al (1999) Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 10(4):259–264

    Article  CAS  PubMed  Google Scholar 

  15. Grados F et al (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39(12):1410–1414

    Article  CAS  Google Scholar 

  16. Greene DL et al (2007) The eggshell technique for prevention of cement leakage during kyphoplasty. J Spinal Disord Tech 20(3):229–232

    Article  PubMed  Google Scholar 

  17. Felsenberg D et al (2002) Incidence of vertebral fracture in europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17(4):716–724

    Article  Google Scholar 

  18. Hiwatashi A et al (2003) Increase in vertebral body height after vertebroplasty. AJNR Am J Neuroradiol 24(2):185–189

    PubMed  Google Scholar 

  19. Hulme PA et al (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976) 31(17):1983–2001

    Google Scholar 

  20. Kim MJ et al (2006) Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions. Spine (Phila Pa 1976) 31(18):2079–2084

    Google Scholar 

  21. Kim SH et al (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45(4):440–445

    Article  CAS  PubMed  Google Scholar 

  22. Klotzbuecher CM et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739

    Article  CAS  PubMed  Google Scholar 

  23. Komemushi A et al (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 29(4):580–585

    Article  PubMed  Google Scholar 

  24. Kuklo TR et al (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976) 26(1):61–65 (discussion 66)

    CAS  Google Scholar 

  25. Leib ES et al (2004) Official positions of the International Society for Clinical Densitometry. J Clin Densitom 7(1):1–6

    Article  PubMed  Google Scholar 

  26. Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26(14):1547–1554

    Article  CAS  PubMed  Google Scholar 

  27. Lin EP et al (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25(2):175–180

    PubMed  Google Scholar 

  28. Lindsay R, Burge RT, Strauss DM (2005) One year outcomes and costs following a vertebral fracture. Osteoporos Int 16(1):78–85

    Article  CAS  PubMed  Google Scholar 

  29. Lindsay R et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323

    Article  CAS  PubMed  Google Scholar 

  30. Lunt M et al (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33(4):505–513

    Article  PubMed  Google Scholar 

  31. McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18(1):24–29

    Article  PubMed  Google Scholar 

  32. Melton LJ 3rd et al (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221

    Article  PubMed  Google Scholar 

  33. Perez-Higueras A et al (2002) Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology 44(11):950–954

    Article  CAS  PubMed  Google Scholar 

  34. Phillips FM et al (2002) An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine (Phila Pa 1976) 27(19):2173–2178 (discussion 2178–2179)

    Google Scholar 

  35. Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976) 28(10):991–996

    Google Scholar 

  36. Takata S, Yasui N (2001) Disuse osteoporosis. J Med Invest 48(3–4):147–156

    CAS  PubMed  Google Scholar 

  37. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine (Phila Pa 1976) 31(23):2747–2755

    Google Scholar 

  38. Teng MM et al (2003) Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol 24(9):1893–1900

    PubMed  Google Scholar 

  39. Uppin AA et al (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226(1):119–124

    Article  PubMed  Google Scholar 

  40. Villarraga ML et al (2005) The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies. J Spinal Disord Tech 18(1):84–91

    Article  PubMed  Google Scholar 

  41. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718

    Article  PubMed  Google Scholar 

  42. Yeom JS et al (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 85(1):83–89

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I. Movrin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Movrin, I., Vengust, R. & Komadina, R. Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg 130, 1157–1166 (2010). https://doi.org/10.1007/s00402-010-1106-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-010-1106-3

Keywords

Navigation