Incidence of Subsequent Vertebral Fracture after Kyphoplasty

Abstract

This study demonstrated a higher rate of subsequent fracture after kyphoplasty compared with natural history data for untreated fractures. Most of these occurred at an adjacent level within 2 months of the index procedure. After this 2-month period, there were only occasional subsequent fractures, which occurred at remote levels. This confirms biomechanical studies showing that cement augmentation places additional stress on adjacent levels. Patients with an increase in back pain after kyphoplasty should be evaluated carefully for subsequent adjacent fractures, especially during the first 2 months after the index procedure.

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

“…This disadvantage has been surmounted by using previously described surrogate measures of functional outcome including in-hospital complications [3,5,10,11,33,52,53], in-hospital mortality [1,3,10,33,53], and patient disposition at hospital discharge [10,11,33,52,53]. Third, evidence is mounting to suggest patients who undergo kyphoplasty experience up to 36% higher risk of subsequent VCF resulting from the increased biomechanical stiffness of the treated vertebral body [22,29,45]. The NIS database contains the information pertaining to a specific hospitalization for a given patient whose identification has been removed from the record.…”

Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review

“…Noncomparative studies: The results of eight studies [4,12,15,20,31,42,43] show that 87 of the 450 patients included developed new vertebral fractures during the follow-up period. The combined analysis of these studies shows (Fig.…”

“…In five studies [4,12,20,42] it was seen that 33 of the patients developed new fractures in levels adjacent to the treated levels, and two of these studies [12,13] report that most such fractures occur in the first 2 months after BK. Comparative studies: As can be seen in Table 6, the combined analysis of two studies [25,26] indicates that patients subjected to kyphoplasty are at a significantly lesser risk of suffering new fractures 6 months after the procedure than patients in the comparator group subjected to medical management.…”

“…NK None NK Theodorou et al [53] None None NK Coumans et al [9] 2.7% Acute myocardial infarction MI 1 NK Garfin [15] 10% Rib fracture 1, Arrhythmia 1 11.5% Ledlie and Renfro [28] 9% Respiratory failure, Deep venous thrombosis NK Lieberman and Reinhardt [31] <5% NK 21% Phillips [40] 9.8% Acute myocardial infarction, Arrhythmia, Urinary retention 17% Wilhelm et al [40] 17.8% Transient lesion of L2 NK Berlemann et al [4] 33% Digestive bleeding 4% Crandall et al [10] None Arrhythmia NK Fribourg et al [12] NA NA 26% Gaitanis et al [13] 9.8% Transient fever 7.4% Grohs and Krepler [18] 2% NK 11% Harrop et al [20] NA NA 23% Heini and Orler [21] 33% None NK Hillmeier et al [22] 9% Epidural hemorrhage, Transient spinal cord lesion NK Masala et al [34] None None NK Rhyne et al [43] 9.8% None 13.5%…”

Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage

“…The incidence of vertebral fractures for women above the age of 80 may increase above 50% [2]. The increased local stiffness after vertebral augmentation in an otherwise osteoporotic spine bears the risk of a higher incidence of fractures of the adjacent vertebrae and thus prophylactic reinforcement of adjacent vertebrae with a high fracture risk is advisable in certain cases [3,4]. Due to the risk of fat embolism, the number of augmented vertebrae during prophylactic multisegmental vertebroplasty should be limited to six levels per session or 25-30 cc of PMMA or flushed out bone marrow, respectively [5].…”