A Longitudinal Cohort Investigation of the
Development of Symptomatic Adjacent Level
Compression Fractures Following Balloonassisted Kyphoplasty in a Series of 726 Patients

Background: Balloon-assisted kyphoplasty (BAK) is a well-accepted treatment for symptomatic vertebral compression fractures (VCF) secondary to osteoporosis. Some have raised a concern of an increased incidence of adjacent fractures due to alterations in spine biomechanics after cement augmentation. The incidence of subsequent VCFs following BAK is poorly understood. The aim of this study was to investigate the timing, location, and incidence of new VCFs following BAK and to identify risk factors associated specifically with the occurrence of new adjacent level fractures. Objectives: The study was performed to determine the incidence of symptomatic subsequent adjacent and remote level compression fractures in a cohort of patients undergoing BAK. Study Design: Longitudinal cohort investigation at an academic medical center and a central referral center for VCFs. Setting: A consecutive single surgeon series of 726 patients with osteoporotic compression fractures. Methods: A prospectively collected cohort of 726 patients who underwent BAK between 2001 and 2014 for osteoporotic VCFs was evaluated. Seventy-seven patients were identified who underwent a second BAK for a new compression fracture and were include in the present series. The indication for BAK treatment was pain unresponsive to non-surgical management for all cases. Variables were recorded for each patient, including the time between index and subsequent fracture, fracture level, and number of initial fractures as well as with tobacco use, body mass index (BMI), and chronic steroid use. Results: Seventy-seven of 726 patients (10.6%) underwent a second BAK procedure on average 350 days following the initial procedure (range 21 to 2,691 days). Third and fourth procedures were less common, treated in 11 and 3 patients, respectively. Forty-eight of 77 patients (62%) suffered a fracture at a level immediately adjacent to the index level at mean time of 256 days. Remote level fractures were treated at a mean time of 489 days, but no statistical difference was noted. There was no statistically significant difference between tobacco use, BMI, and chronic steroid use between patients suffering from remote and adjacent level VCFs. Limitations: This was not a population based study, and the true incidence of subsequent fractures after BAK might be underestimated by this analysis. Conclusions: Symptomatic compression fractures after BAK are relatively uncommon and may occur long after the initial kyphoplasty procedure. Only half of subsequent fractures occur immediately adjacent to the initially treated level; the others occur remotely. Patients with a single symptomatic thoracic or lumbar fracture suffered from remote and adjacent level fractures equally. In contrast, all patients who suffered both a thoracic and lumbar fracture at the same time had a second fracture at an adjacent level. Specific risk factors for remote versus adjacent level fractures could not be determined. Key words: Balloon kyphoplasty, cement augmentation, osteoporosis, vertebral compression fracture, adjacent level fracture, vertebroplasty

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Cortical screw trajectory for instrumentation and fusion in the setting of osteopathic compression fracture allows for percutaneous kyphoplasty for adjacent level compression fractures

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2014.09.025 ◽

2015 ◽

Vol 22 (5) ◽

pp. 899-904 ◽

Cited By ~ 6

Author(s):

Donato Pacione ◽

Irene Kim ◽

Taylor A. Wilson ◽

Anthony Frempong-Boadu

Keyword(s):

Compression Fracture ◽

Adjacent Level ◽

Compression Fractures ◽

Percutaneous Kyphoplasty ◽

Cortical Screw

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Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2021/24/e335 ◽

2021 ◽

pp. E335-E340

Author(s):

Weihua Cai

Keyword(s):

Risk Factors ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Hounsfield Units ◽

Secondary Fracture ◽

Compression Fractures ◽

Fracture History ◽

Primary Fracture

Background: In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. Objectives: To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Study Design: Retrospective study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Results: Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 – 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 – 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. Limitations: The main limitation is the retrospective nature of this study. Conclusion: Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention. Key words: Risk factor, vertebral, secondary fracture, osteoporosis

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Correlation Between Bone Density and Lumbar Compression Fractures

Gerontology and Geriatric Medicine ◽

10.1177/2333721420914771 ◽

2020 ◽

Vol 6 ◽

pp. 233372142091477

Author(s):

Toshihide Takahashi ◽

Tomoya Takada ◽

Takeshi Narushima ◽

Atsuro Tsukada ◽

Eiichi Ishikawa ◽

...

Keyword(s):

Lumbar Spine ◽

Bone Density ◽

Bone Densitometry ◽

Compression Fracture ◽

Spine Fractures ◽

Image Information ◽

Compression Fractures ◽

Lumbar Fracture ◽

Vertebral Bodies ◽

Lumbar Fractures

Objectives: Bone densitometry is widely used to evaluate osteoporosis; however, it is pointed out that bone density may be high in the case of fractures, deformities, and osteosclerotic changes. The present study evaluated bone density measured at our hospital and evaluated its correlation with the presence or absence of lumbar spine fractures. Methods: Bone density of the lumbar spine and femur was measured in 185 patients from July 2017 to June 2019 at our hospital, and the presence or absence of a lumbar spine compression fracture was evaluated on the basis of the image. Information regarding age, sex, lumbar bone density, presence or absence of lumbar fracture, number of lumbar fractures, and grade of lumbar fracture was also statistically evaluated. Results: Analysis was performed for 185 patients (20 males and 165 females, average age 76.9 ± 7.5 years). The bone density was 0.830 ± 0.229 of compression fractured bodies (number of vertebral bodies were 132) and 0.765 ± 0.178 g/cm3 of noncompression fractured bodies (number of vertebral bodies was 608). Discussion: The presence of lumbar fractures significantly increases bone density. For diagnosing osteoporosis, both bone density and the possibility of lumbar spine fractures must be considered.

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Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/315 ◽

2020 ◽

Vol 3;23 (6;3) ◽

pp. 315-323

Author(s):

David Gimarc

Keyword(s):

Cohort Study ◽

Vertebral Body ◽

Complete Resolution ◽

Tertiary Care ◽

Compression Fracture ◽

Cement Augmentation ◽

Common Symptom ◽

Compression Fractures ◽

Fracture Location ◽

Relative Improvement

Background: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. Study Design: Retrospective cohort study. Setting: Interventional pain practice in a tertiary care university hospital. Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient’s relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). Results: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. Limitations: This retrospective study used an electronic chart review of clinicians’ notes to determine the presence of radiculopathy and their relative improvement following the procedure. Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. Key words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation

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Risk Factors for the Occurrence of Insufficient Cement Distribution in the Fractured Area after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e33 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E33-E42

Author(s):

Xiaobing Jiang

Keyword(s):

Risk Factors ◽

Pain Relief ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Bone Mass Density ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Cement Distribution ◽

Superior Portion

Background: Insufficient cement distribution (ICD) in the fractured area has been advocated to be responsible for unsatisfied pain relief after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). However, little is known about risk factors for the occurrence of ICD. Objective: The present study aimed to identify independent risk factors of the emergence of ICD. Study Design: A retrospective cohort study. Setting: Department of spinal surgery, an affiliated hospital of a medical university. Methods: Patients who underwent PVP for single-level OVCF from January 2012 to September 2014 and met this study’s inclusion criteria were retrospectively reviewed. Associations of ICD with co-variates (age, gender, bone mass density with a T-score, amount of injected cement, cement leakage, fracture level, fracture age, fracture severity grade, and location of the fractured area) and the influence of ICD on pain relief were analyzed. Results: A total of 225 patients were included. ICD was found in 26 (11.6%) patients. Fractured area located in the superior portion of the index vertebra was significantly associated with occurrence of ICD. No further significant associations between the studied co-variates and emergence of ICD were seen in the adjusted analysis. In addition, patients with ICD had significantly higher immediate postoperative visual analog scale scores of back pain compared with those with sufficient cement distribution in the fractured area. Limitation: Location of the fractured area and cement distribution in the fractured area could not be evaluated quantitatively. Conclusions: The incidence of ICD is higher in patients with the fractured area located in the superior portion of the index vertebra and ICD might be responsible for unsatisfied pain relief after PVP for OVCFs. Key words: Percutaneous vertebroplasty, insufficient cement distribution, fractured area, risk factor, osteoporosis, vertebral compression fracture, spine, unsatisfied pain relief, cement augmentation

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Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02722-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wei Mao ◽

Fei Dong ◽

Guowei Huang ◽

Peiliang He ◽

Huan Chen ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Secondary Fracture ◽

Compression Fractures ◽

Secondary Fractures ◽

At Home

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. Methods The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. Results A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. Conclusion The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.

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Risk Factors of New Vertebral Compression Fracture After Percutaneous Kyphoplasty or Vertebroplasty: A Retrospective Study of 752 Patients

10.21203/rs.3.rs-1057960/v1 ◽

2021 ◽

Author(s):

Bo-bo Zhang ◽

Zhong-wei Song ◽

Ying Wang ◽

Zhi-wei Ren ◽

Wei-zhou Yang ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Compression Fracture ◽

Osteoporosis Treatment ◽

Vertebral Compression Fractures ◽

Height Loss ◽

Mineral Density ◽

Compression Fractures ◽

Factors Associated ◽

Significant Difference

Abstract Summary Irregularly postoperative anti-osteoporosis treatment (AOT), number of treated vertebrae (NTV) ≥ 2, bone mineral density (BMD) ≤－3.0 SDs, body mass index (BMI) <18.5kg/m2 or BMI ≥ 24kg/m2, vertebral height loss ratio (VHLR)＞20% were strong risk factors associated with new vertebral compression fractures (NVCF) after percutaneous vertebroplasty or kyphoplasty (PVP/PKP) in patients with osteoporotic vertebral compression fractures (OVCF). There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention.Introduction NVCF have been connected to PVP/PKP surgery for patients with VCF. There are some debates about whether new vertebral body fractures are simply a result of the natural progression of osteoporosis or whether they should be regarded as a consequence of augmentation. We tried to investigate and identify the risk factors which may be relevant to NVCF after PVP/PKP surgery in OVCF patients.Methods The authors retrospectively analyzed the occurrence of NVCF in 752 patients treated with PVP or PKP for OVCF. Possible risk factors, such as age, gender, refracture time (RT), AOT, NTV, BMD, BMI, and VHLR, were assessed.All methods are carried out in accordance with relevant guidelines and regulations.Results Significant differences (P<0.05) were found between the NVCF and control groups with regard to AOT, number of treated vertebrae, BMD, BMI, and VHLR by univariate analysis. And irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI < 18.5 kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were found to be the significant factors in multivariate analysis. To evaluate a direct and more precise effect of the procedures on untreated vertebrae, the NVCF group was subdivided into adjacent and remote fracture groups. All of factors have no significant difference between two subgroups.Conclusion In the current study, the incidence of NVCF after PVP/PKP is 9.58%. Irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI <18.5kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were strong risk factors associated with NVCF after PVP/PKP in patients with OVCF. There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention and that might be the result of the osteoporosis itself. All of those should be addressed during preoperative communication and postoperative management.

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BIOMECHANICAL EVALUATION OF LOW-MODULUS BONE CEMENT FOR ENHANCING APPLICABILITY IN VERTEBROPLASTY — AN EXPERIMENTAL STUDY IN PORCINE MODEL

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237218500023 ◽

2018 ◽

Vol 30 (01) ◽

pp. 1850002

Author(s):

Mu-Yi Liu ◽

Po-Liang Lai ◽

Ching-Lung Tai

Keyword(s):

Vertebral Compression Fracture ◽

Compression Fracture ◽

Cement Augmentation ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Height ◽

Compression Fractures ◽

Significant Difference ◽

Compression Stiffness ◽

Low Modulus

Polymethylmethacrylate (PMMA) bone cement has been widely used in vertebroplasty to treat osteoporotic vertebral compression fracture. However, the high compression stiffness of PMMA is suspected to induce adjacent vertebral fracture following vertebroplasty. In the current study, modified low-modulus cement was prepared by combining PMMA with castor oil to solve this problem. The percentage of height recovery and compression stiffness of vertebral bodies was compared after injection of standard PMMA or low-modulus cement. This study aims to investigate whether low-modulus cement is as effective as standard PMMA for storing the initial vertebral height; while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. A total of 20 fresh porcine lumbar vertebrae were assigned into two groups (10 per group): standard and low-modulus. All specimens received a four-week decalcification to mimic human osteoporotic vertebrae. The standard and low-modulus groups received a simulated compression fracture followed by treatment of standard and low-modulus cement augmentation, respectively. The low-modulus cement was prepared by combining standard PMMA with 15% weight fractions of castor oil. For all the 20 specimens, vertebral compression fracture was created by reducing the vertebral height of 25% using a material testing machine. The compression stiffness determined from the creation of compression fracture was defined as the intact group (20 specimens). The fractured vertebrae were then treated with standard and low-modulus cement augmentation. The vertebral height was measured pre- and post-treatment, and the percentage of vertebral height recovery was compared between two cementing groups. Following cement augmentation, axial compression test was conducted to compare compression stiffness among three groups. The results indicated that there is no significant difference in percentage of vertebral height between standard (83.42[Formula: see text][Formula: see text][Formula: see text]11.60%) and low-modulus (88.50[Formula: see text][Formula: see text][Formula: see text]6.15%) groups ([Formula: see text]). Moreover, the compression stiffnesses were 1166.49[Formula: see text][Formula: see text][Formula: see text]392.91 N/mm, 1795.85[Formula: see text][Formula: see text][Formula: see text]247.45[Formula: see text]N/mm and 1362.57[Formula: see text][Formula: see text][Formula: see text]236.92[Formula: see text]N/mm for intact, standard and low-modulus groups, respectively. There is significant difference among three groups ([Formula: see text]). We concluded that the modified low-modulus cement is as effective as standard PMMA for storing the initial vertebral height while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. These reduce the risks of adjacent vertebral body fracture following vertebroplasty.

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