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Archives of Osteoporosis

, 13:82 | Cite as

Single-level vertebral kyphoplasty is not associated with an increased risk of symptomatic secondary adjacent osteoporotic vertebral compression fractures: a matched case–control analysis

  • Henrik Teuber
  • Simon Tiziani
  • Sascha Halvachizadeh
  • Diana Frey
  • Kai Sprengel
  • Hans-Christoph Pape
  • Georg OsterhoffEmail author
Original Article
  • 80 Downloads

Abstract

Summary

This matched case–control study compared the rate of symptomatic adjacent-level vertebral compression fractures (VCF) within 1 year in patients operatively treated with kyphoplasty to a control group of non-operatively treated VCFs. The adjacent-level fracture rate did not show a significant difference between groups.

Purpose

To compare the rate of new symptomatic adjacent-level fractures within 1 year after an isolated osteoporotic vertebral compression fracture (VCF) treated by either kyphoplasty or non-operative treatment.

Methods

Patients aged ≥ 50 years with an isolated, fresh, and symptomatic osteoporotic VCF who were treated by kyphoplasty were compared to patients of similar age, gender, vertebral segment, and bone mineral density who were treated non-operatively (n = 98). A matched case–control analysis was conducted by retrospective chart review, and the rate of new adjacent-level symptomatic vertebral fractures, defined as occurring within two segments of the index fracture, within the first year was determined.

Results

Ninety-eight patients (66 female, aged 73.5, SD 9.7 years) were analyzed in this matched case–control study. The adjacent fracture rate within 1 year was not different between the kyphoplasty group and the non-operative group (20.4 vs 18.4%; McNemar, p = 1.0). The time to a new adjacent fracture after the index fracture was significantly shorter in the kyphoplasty (7, SD 8 weeks) versus non-operative group (22, SD 13 weeks).

Conclusions

Patients with osteoporotic VCFs treated with kyphoplasty did not show an increased rate of additional symptomatic adjacent-level VCFs when compared to a non-operative control group matched for age, gender, fracture level, and bone mineral density.

Level of Evidence: Level III.

Keywords

Vertebral compression fracture Spinal fracture Kyphoplasty Adjacent-level vertebral fracture Adjacent vertebral fracture Osteoporosis Dual energy X-ray absorptiometry Bone mineral density 

Notes

Compliance with ethical standards

The study was approved by the local ethics committee (Kantonale Ethik-Kommission Zürich, KEK-ZH-Nr. 2017-00408).

Conflicts of interest

Georg Osterhoff has given paid lectures for Medtronic, Stryker, and Stöckli Medical, all three being manufacturers or distributors of kyphoplasty systems. Henrik Teuber, Simon Tiziani, Sascha Halvachizadeh, Diana Frey, Kai Sprengel, and Hans-Christoph Pape declare that they have no conflict of interest.

References

  1. 1.
    Gauthier A, Kanis JA, Jiang Y, Martin M, Compston JE, Borgstrom F, Cooper C, McCloskey EV (2011) Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos 6:179–188CrossRefGoogle Scholar
  2. 2.
    Wagner D, Kamer L, Sawaguchi T, Richards RG, Noser H, Rommens PM (2016) Sacral bone mass distribution assessed by averaged three-dimensional CT models: implications for pathogenesis and treatment of fragility fractures of the sacrum. J Bone Joint Surg Am 98:584–590CrossRefGoogle Scholar
  3. 3.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRefGoogle Scholar
  4. 4.
    Babayev M, Lachmann E, Nagler W (2000) The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil 79:404–409CrossRefGoogle Scholar
  5. 5.
    Mears SC, Berry DJ (2011) Outcomes of displaced and nondisplaced pelvic and sacral fractures in elderly adults. J Am Geriatr Soc 59:1309–1312CrossRefGoogle Scholar
  6. 6.
    Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine (Phila Pa 1976) 31:1983–2001CrossRefGoogle Scholar
  7. 7.
    Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024CrossRefGoogle Scholar
  8. 8.
    McArthur N, Kasperk C, Baier M et al (2009) 1150 kyphoplasties over 7 years: indications, techniques, and intraoperative complications. Orthopedics 32:90PubMedGoogle Scholar
  9. 9.
    Luo J, Adams MA, Dolan P (2010) Vertebroplasty and kyphoplasty can restore normal spine mechanics following osteoporotic vertebral fracture. J Osteoporos 2010:729257CrossRefGoogle Scholar
  10. 10.
    Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2009) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20:819–826CrossRefGoogle Scholar
  11. 11.
    Harrop JS, Prpa B, Reinhardt MK, Lieberman I (2004) Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty. Spine 29:2120–2125CrossRefGoogle Scholar
  12. 12.
    Lavelle WF, Cheney R (2006) Recurrent fracture after vertebral kyphoplasty. Spine J 6:488–493CrossRefGoogle Scholar
  13. 13.
    Movrin I (2012) Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy. Wien Klin Wochenschr 124:304–311CrossRefGoogle Scholar
  14. 14.
    Yi X, Lu H, Tian F, Wang Y, Li C, Liu H, Liu X, Li H (2014) Recompression in new levels after percutaneous vertebroplasty and kyphoplasty compared with conservative treatment. Arch Orthop Trauma Surg 134:21–30CrossRefGoogle Scholar
  15. 15.
    Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D (2011) Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res 26:1627–1637CrossRefGoogle Scholar
  16. 16.
    Zhang H, Xu C, Zhang T, Gao Z, Zhang T (2017) Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A meta-analysis. Pain physician 20:E13–E28PubMedGoogle Scholar
  17. 17.
    Faloon MJ, Ruoff M, Deshpande C, Hohman D, Dunn C, Beckloff N, Patel DV (2015) Risk factors associated with adjacent and remote-level pathologic vertebral compression fracture following balloon kyphoplasty: 2-year follow-up comparison versus conservative treatment. 25:313–319Google Scholar
  18. 18.
    Rho Y-J, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J 21:905–911CrossRefGoogle Scholar
  19. 19.
    Ning L, Wan S, Liu C, Huang Z, Cai H, Fan S (2015) New levels of vertebral compression fractures after percutaneous kyphoplasty: retrospective analysis of styles and risk factors. Group 77:0.025Google Scholar
  20. 20.
    Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 93:1057–1063CrossRefGoogle Scholar
  21. 21.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259CrossRefGoogle Scholar
  22. 22.
    Werner CM, Osterhoff G, Schlickeiser J, Jenni R, Wanner GA, Ossendorf C, Simmen H-P (2013) Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a randomized trial. JBJS 95:577–584CrossRefGoogle Scholar
  23. 23.
    Breslow NE, Day NE (1980) Statistical methods in cancer research. Volume I—the analysis of case–control studies. IARC Sci Publ:5–338Google Scholar
  24. 24.
    Gerszten PC (2016) A longitudinal cohort investigation of the development of symptomatic adjacent level compression fractures following balloon-assisted kyphoplasty in a series of 726 patients. Pain Physician 19:E1167–E1172PubMedGoogle Scholar
  25. 25.
    Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC (2010) Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 11:1659–1665CrossRefGoogle Scholar
  26. 26.
    Diamond TH, Bryant C, Browne L, Clark WA (2006) Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 184:113–117PubMedGoogle Scholar
  27. 27.
    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 114:257–265CrossRefGoogle Scholar
  28. 28.
    Klazen CA, Lohle PN, de Vries J et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092CrossRefGoogle Scholar
  29. 29.
    Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Am J Neuroradiol 27:217–223Google Scholar
  30. 30.
    Boonen S, Eastell R, Su G, Mesenbrink P, Cosman F, Cauley JA, Reid IR, Claessens F, Vanderschueren D, Lyles KW, Black DM (2012) Time to onset of antifracture efficacy and year-by-year persistence of effect of zoledronic acid in women with osteoporosis. J Bone Miner Res 27:1487–1493CrossRefGoogle Scholar
  31. 31.
    Schönenberg D, Guggenberger R, Frey D, Pape H-C, Simmen H-P, Osterhoff G (2018) CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case–control analysis. Osteoporos Int 29:459–465CrossRefGoogle Scholar
  32. 32.
    Mannil M, Eberhard M, Becker AS, Schönenberg D, Osterhoff G, Frey DP, Konukoglu E, Alkadhi H, Guggenberger R (2017) Normative values for CT-based texture analysis of vertebral bodies in dual X-ray absorptiometry-confirmed, normally mineralized subjects. Skelet Radiol 46:1541–1551CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Henrik Teuber
    • 1
  • Simon Tiziani
    • 1
  • Sascha Halvachizadeh
    • 1
  • Diana Frey
    • 2
  • Kai Sprengel
    • 1
  • Hans-Christoph Pape
    • 1
  • Georg Osterhoff
    • 1
    Email author
  1. 1.Department of TraumaUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of RheumatologyUniversity Hospital ZurichZürichSwitzerland

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