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OBJECTIVE This study investigated the benefit of prophylactic vertebroplasty of the adjacent vertebrae in single-segment osteoporotic vertebral body fractures treated with kyphoplasty. METHODS All patients treated with kyphoplasty for osteoporotic single-segment fractures between January 2007 and August 2012 were included in this retrospective study. The patients received either kyphoplasty alone (kyphoplasty group) or kyphoplasty with additional vertebroplasty of the adjacent segment (vertebroplasty group). The segmental kyphosis with the rate of adjacent-segment fractures (ASFs) and remote fractures were studied on plain lateral radiographs preoperatively, postoperatively, at 3 months, and at final follow-up. RESULTS Thirty-seven (82%) of a possible 45 patients were included for the analysis, with a mean follow-up of 16 months (range 3–54 months). The study population included 31 women, and the mean age of the total patient population was 72 years old (range 53–86 years). In 21 patients (57%), the fracture was in the thoracolumbar junction. Eighteen patients were treated with additional vertebroplasty and 19 with kyphoplasty only. The segmental kyphosis increased in both groups at final follow-up. A fracture through the primary treated vertebra (kyphoplasty) was found in 4 (22%) of the vertebroplasty group and in 3 (16%) of the kyphoplasty group (p = 0.6). An ASF was found in 50% (n = 9) of the vertebroplasty group and in 16% (n = 3) of the kyphoplasty group (p = 0.03). Remote fractures occurred in 1 patient in each group (p = 1.0). CONCLUSIONS Prophylactic vertebroplasty of the adjacent vertebra in patients with single-segment osteoporotic fractures as performed in this study did not decrease the rate of adjacent fractures. Based on these retrospective data, the possible benefits of prophylactic vertebroplasty do not compensate for the possible risks of an additional cement augmentation.

Background: Sagittal spinopelvic parameters remain poorly defined in patients with Scheuermann disease (SD). For example, although pelvic incidence (PI) should approximate lumbar lordosis (LL) by 108, this is not true in patients with SD. This retrospective radiographic study was conducted to propose a new mathematical relationship between sagittal spinopelvic parameters in skeletally mature patients with SD. Methods: The following formula (D) was proposed [(thoracic kyphosis-458) þ (thoracolumbar kyphosis-08) þ (PI-LL) ¼ 6 108] and validated with standard spino pelvic parameters in patients with skeletally mature SD without prior spine surgery at 2 centers between 2006 and 2015. The T1 pelvic angle (TPA) was used as a measure of global balance with normal maximum of 158. Subgroup analysis was performed to compare D between balanced (TPA 158) and unbalanced (TPA. 158) patients with SD. Results: In patients with SD (n ¼ 30), half were female (n ¼ 15), the average age was 39 years, and the average D was 2.48. A significant correlation was discovered between D and both TPA (R 2 ¼ 0.75) and PI (R 2 ¼ 0.69). At TPA of 158, average D was 9.28. There was also a significant difference between balanced and unbalanced patients (À8.78 6 11.68 versus 28.28 6 19.78, P ¼ .0003). Conclusions: This study of a new formula (D) to evaluate global sagittal balance in patients with SD found that accounting for the kyphosis maintained D within 6 108. Further study is planned to determine whether maintaining and/or restoring a normal D is associated with improved outcomes in patients with SD after surgery.

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