Radiographic Factors for Adjacent Vertebral Fractures and Cement Loosening Following Balloon Kyphoplasty in Patients with Osteoporotic Vertebral Fractures

Abstract

Introduction: Balloon kyphoplasty (BKP) is a minimally invasive surgical approach for the treatment of osteoporotic vertebral fractures (OVF). Some risks have been reported after treatment with BKP; therefore, it is necessary to determine when BKP does not work. Thus, in this study, we aim to clarify the radiographic predictors of secondary vertebral fractures and cement loosening after BKP for OVF. Methods: This study enrolled patients with single-level OVF at the thoracolumbar junction (T11-L2) who underwent BKP for the first time between January 2011 and March 2014. The clinical outcomes were evaluated using the visual analog scale (VAS) and a modified Oswestry Disability Index (ODI) at 1 week and 1, 3, 6, and 12 months after surgery. Radiographic assessments were performed preoperatively and within 1 year after BKP using plain radiography and computed tomography. Results: The 85 patients who met the inclusion criteria underwent BKP. The average age of participants (21 men, 64 women) was 77.8 years (range, 57-92 years). Postoperative VAS and ODI scores were all significantly better than preoperative scores. Polymethyl methacrylate (PMMA)-cement leakage was observed in 18 patients (21.2%) but was asymptomatic in all cases. Secondary vertebral fractures were detected in 20 patients (23.5%), including adjacent levels in 15 patients (17.6%) and non-adjacent levels in 5 patients (5.9%). Rostral bridging osteophyte formation was found to be significantly associated with the occurrence of adjacent vertebral fractures (odds ratio 12.746; p = 0.010). PMMA-cement loosening was observed in

Prognostic factors of balloon kyphoplasty for osteoporotic vertebral fractures with diffuse idiopathic skeletal hyperostosis

“…In our previous study, preoperative changes in the vertebral wedge angle tended to be greater in patients with loosening around the PMMA after BKP for OVFs; however, this could not be statistically evaluated because only 3 patients demonstrated loosening around the PMMA. 9 In the present study, the cutoff value for the change in wedge angle for delayed bone healing in ROC analysis was 10°. In a previous study on thoracolumbar OVFs, the stability of a fractured vertebra was evaluated via the difference in the wedge angle of the vertebra by using lateral radiographs measured in flexion and extension; here, a value > 11° was identified as dynamic instability, and fusion surgery was recommended instead of kyphoplasty.…”

“…22 Our previous study showed that intervertebral bridging osteophyte formation on the cephalad side of the fractured vertebra was a risk factor for adjacent vertebral fracture and loosening around the PMMA cement after BKP; however, even among patients with intervertebral bridging osteophytes, 18/32 (56.3%) exhibited no postoperative complications. 9 There are also a few previous reports of successful percutaneous vertebroplasties for vertebral fractures in patients with DISH. 12,23 The present study showed that fractures of the most distal or distal-adjacent vertebrae of ankylosing spines were stabilized by bone healing in 51/89 patients (57.3%) 6 months after BKP.…”

“…2B) positions immediately before surgery. 9 The degree of change in the vertebral wedge angle was assessed as the difference in this angle between the supine and sitting positions on plain lateral radiographic scans, according to a previous study (β° − α° in Fig. 2).…”

“…2). 9 Intervertebral bridging osteophyte formation was evaluated via CT scans obtained immediately before surgery. The clinical and radiographic characteristics of the patients immediately before surgery, including age, sex, time from onset to surgery, VAS score, ODI score, bone densities of the left proximal femur and lumbar spine, vertebral wedge angle in the supine and sitting positions, degree of change in the vertebral wedge angle, and amount of PMMA cement infused into fractured vertebrae, were analyzed as possible factors associated with delayed bone healing 6 months after BKP.…”

“…15,16 Although the treatment of ankylosing spinal fractures requires fusion surgery similar to that required for long bone fractures, the indications for BKP in fractures of the terminal or adjacent vertebral bodies of ankylosing spines remain controversial. 9,17 Therefore, the purpose of this study was to determine the poor prognostic factors of BKP for the treatment of fractures of the most distal or distal-adjacent vertebrae of ankylosing spines with DISH.…”