The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study

Abstract

BackgroundPercutaneous kyphoplasty (PKP) is the first-line treatment for osteoporotic vertebral compression fractures (OVCFs) that can immediately relieve pain and allow the quick recovery of lost mobility. However, some studies reported that after PKP, the incidence of vertebral refracture, particularly adjacent vertebral fracture (AVF), was high. Our previous meta-analysis suggested that the risks for vertebral refracture and AVF did not increase after percutaneous vertebral augmentation in OVCF patients. Despite the negative results of our meta-analysis, there is still significant evidence regarding the relationship between kyphoplasty and AVF, so a new prospective cohort study is warranted. In addition, in our previous retrospective study, we found that advanced age, female sex and low oestradiol (E2) concentrations might be related to the occurrence of postoperative vertebral refracture after PKP. To sufficiently evaluate the probable factors involved in the occurrence of postoperative vertebral refracture, we designed this prospective study.MethodsThis is a prospective cohort study of patients admitted for PKP to treat painful OVCFs. The baseline data, including demographic information, lifestyle, bone metabolic status, sex hormone and sex hormone-binding globulin (SHBG) levels, and clinical characteristics will be collected at the time of enrolment. Surgical features of PKP will be recorded on the operation day. Lifestyle, bone metabolic status, sex hormone levels, and SHBG levels will be assessed during the follow-up period at 1 m, 3 m, 12 m, and 24 m postoperatively. Patients suffering from acutely aggravated back pain will be referred to an orthopaedist, and refractured vertebrae will be confirmed by magnetic resonance imaging and computed tomography. The primary outcome will be the incidence of vertebral refracture. Multivariate analyses will be carried out to evaluate the variables that are independently correlated with vertebral refracture.DiscussionTo evaluate the risk of postoperative refracture preoperatively and to identify the surgical points related to postoperative refracture, this study will explore the risk factors related to vertebral refracture after PKP. The results may provide new information about defining OVCF patients suitable for PKP treatment.Trial registrationChiCTR-ROC-17011562. Registered on July 4th, 2017.

Effect of Preoperative Zoledronic Acid Administration on Pain Intensity after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

“…Some scholars believe that PVP only relieves acute pain caused by the fracture but fails to relieve the pain caused by osteoporosis. At the same time, some scholars believe that the postoperative strength of the vertebral body with compression fracture increases, changing the mechanical structure and transmission mechanism of the normal vertebral bodies, aggravating the load of the adjacent vertebral bodies, and thus increasing the risk of fracture of the adjacent vertebral bodies or causing occult trabecular bone fractures in the adjacent vertebral bodies, which will result in postoperative residual pain [ 14 ]. Yang et al performed a statistical analysis for 1316 patients treated with PVP, among which 60 complained of postoperative discomfort, with a prevalence of 4.6%.…”

Kyphosis and canal compromise due to refracturing of an L1 cemented vertebra managed with posterior surgery alone

“…Several studies have demonstrated that the increased “distance between polymethylmethacrylate and the endplate” increases the rate of refracture. [1,5,7] The intervertebral cleft is another risk factor if not properly sealed during the initial procedure. [6]…”

“…The distribution pattern for cement is classified into two types: (1) local solid lumps or (2) the trabecular/diffuse types. [5,7] In the localized solid lump pattern, the cement is confined to a small area within the anterior two-thirds of the vertebral body (e.g., particularly within the middle third of the body); it results in stress shielding, thereby increasing the risk of microfracture and progressive vertebral body height loss within the noncemented areas. For the trabecular or diffuse patterns, the cement is dispersed and fills the trabecular bone of the additional posterior one-third of the vertebral body.…”

“…For the trabecular or diffuse patterns, the cement is dispersed and fills the trabecular bone of the additional posterior one-third of the vertebral body. [5,7]…”

Comparison of Percutaneous Vertebroplasty and Percutaneous Curved Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Distribution of Bone Cement and Complication

“…Some studies had shown that it accounted for 30% -50% of the global population over the age of 50 [1]. The clinical manifestations of osteoporotic vertebral compression fractures include pain, limited physiological function, decreased quality of life, increased mortality and so on [2,3]. It will also increase the risk of adjacent vertebral c fractures in the future [4,5].…”