Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study

Abstract

Introduction Predominantly uncontrolled studies suggest that there may be a greater risk of subsequent vertebral compression fractures (VCFs) associated with vertebroplasty and kyphoplasty. To further understand the risk of VCFs, we conducted a population-based retrospective cohort study using data from a large regional health insurer. Materials and Methods Administrative claims procedure codes were used to identify a treatment group of patients receiving either a vertebroplasty or kyphoplasty (treatment group) and a comparison group of patients with a primary diagnosis of VCF who did not receive treatment during the same time period. The main outcomes of interest, validated by two independent medical record reviewers and adjudicated by a physician panel, were any new VCFs within: 1) 90-days; 2) 360-days; and 3) at adjacent vertebral levels. Multivariable logistic regression examined the association of vertebroplasty/kyphoplasty with new VCFs. Results Among 48 treatment (51% vertebroplasty, 49% kyphoplasty) and 164 comparison patients, treated patients had a significantly greater risk of secondary VCFs than comparison patients for fractures within 90 days of the procedure or comparison group time point (adjusted odds ratio (OR) = 6.3; 95% confidence interval (CI) 1.7 – 23.0) and within 360 days (adjusted OR = 3.1; 95% CI:1.1 – 8.4). Vertebroplasty and kyphoplasty were associated with a significantly greater rate of adjacent-level fractures as well. Conclusions Patients who had undergone vertebroplasty and kyphoplasty had a greater risk of new VCFs compared to patients with prior VCFs who did not undergo either procedure.

Percutaneous Vertebroplasty Is Not a Risk Factor for New Osteoporotic Compression Fractures: Results from VERTOS II

“…Some noncontrolled follow-up studies after PV reported that new VCFs, more often located adjacent to the vertebroplasty level, allegedly contributed to the increased dimensional stability of the cemented vertebral body. 6,8,22,23 However, in our randomized study, no difference in location distribution of new VCFs was found after PV and conservative therapy. In addition, after PV, the risk for a new VCF adjacent to the cemented level was equal to the risk of a new VCF at a distant level.…”

“…[9][10][11][12][13]20 On the other hand, some studies have reported an increased risk of new VCFs after PV. 5,6,8,20,21 However, most of these studies were small nonrandomized follow-up only studies, lacking a control group without intervention. Some noncontrolled follow-up studies after PV reported that new VCFs, more often located adjacent to the vertebroplasty level, allegedly contributed to the increased dimensional stability of the cemented vertebral body.…”

“…However, some authors believe that PV is associated with a higher incidence of new VCFs as a result of the augmented stiffness of the treated vertebra, related to the amount of injected cement or by cement leakage in the adjacent vertebral disk space. [5][6][7][8] Others dispute this assumption and consider the incidence of new VCFs dependent on the presence and severity of osteoporosis. [9][10][11][12][13] To elucidate this controversy, we assessed the incidence of new VCFs during follow-up in 202 patients with acute VCFs randomized to PV and conservative therapy from VERTOS II.…”

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.…”

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

“…New osteoporotic vertebral compression fractures, in the months after VP, are reported in 7-63 % of VP patients, up to 82 % of these occur at the adjacent levels, with adjacent fractures occurring sooner than nonadjacent fractures; rates of recurrent fracture of the augmented vertebra itself range up to 63 % in the literature [1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. It is still under debate whether new vertebral fractures appear more often in patients who received cement augmentation than in conservatively treated patients; some studies support this hypothesis [1,6,7,[27][28][29], while others question it [2,3,26,30]. Reducing the augmentation volume [31], using low-modulus PMMA [32] and prophylactic augmentation of adjacent vertebrae [13,25,33] have been proposed as ways of minimizing the risk of subsequent fractures.…”