Abstract
Summary
We evaluated the relationship between sagittal spinopelvic parameters and the occurrence of adjacent vertebral fractures (AVF) and determined the possible risk factor. The most important factors for AVFs are the degree of osteoporosis and altered biomechanics due to the spinopelvic imbalance in the fractured area of the spine.
Introduction
We intend to evaluate the relationship between sagittal spinopelvic parameters and the occurrence of adjacent vertebral fractures following the initial compression fracture and to determine the possible dominant risk factor associated with new compression fractures.
Methods
From March 2010 to May 2012, 240 consecutive patients with painful vertebral compression fractures (VCFs) were enrolled in a retrospective study. Ninety-one patients with VCFs underwent percutaneous vertebroplasty (VP) at 112 levels. The sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and segmental kyphotic angle on sagittal standing radiographs were used to evaluate radiologic outcomes.
Results
In 2 years, 15 out of 134 patients (11.1 %) treated with conservative treatment, and 12 out of 91 patients (13.1 %) treated with VP sustained adjacent level fracture. More patients with the BMD higher or equal to 3.0 experienced a new fracture than those with a BMD less than 3.0 (p = 0.019), and the risk for adjacent level fractures decreased significantly when segmental kyphotic angle was less than 11° (p = 0.001), SVA was less than 6 cm (p = 0.001), SS was higher or equal to 25° (p = 0.004), and LL was higher or equal to 25° (p = 0.020).
Conclusions
The most important factors for new VCFs after the initial compression fractures are the degree of osteoporosis and altered biomechanics due to the spinopelvic imbalance in the fractured area of the spine. Regarding the spinopelvic alignment to investigate the relationship with a subsequent AVF, segmental kyphotic angle, SS, LL, and SVA may be a potential predictor.
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References
Borgstrom F, Sobocki P, Strom O, Jonsson B (2007) The societal burden of osteoporosis in Sweden. Bone 40:1602–1609
Zethraeus N, Borgstrom F, Strom O, Kanis JA, Jonsson B (2007) Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int 18:9–23
Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976) 26:1511–1515
Takata S, Yasui N (2001) Disuse osteoporosis. J Med Invest 48:147–156
Winking M, Stahl JP, Oertel M, Schnettler R, Boker DK (2004) Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty. Acta Neurochir (Wien) 146:469–476
Zoarski GH, Snow P, Olan WJ, Stallmeyer MJ, Dick BW, Hebel JR, De Deyne M (2002) Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 13:139–148
Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976) 29:2270–2276, discussion 2277
Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414
Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45:440–445
Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25:175–180
Ananthakrishnan D, Berven S, Deviren V, Cheng K, Lotz JC, Xu Z, Puttlitz CM (2005) The effect on anterior column loading due to different vertebral augmentation techniques. Clin Biomech (Bristol, Avon) 20:25–31
Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K (2001) An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine (Phila Pa 1976) 26:151–156
Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Villarraga ML, Bellezza AJ, Harrigan TP, Cripton PA, Kurtz SM, Edidin AA (2005) The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies. J Spinal Disord Tech 18:84–91
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267
Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976) 26:61–65, discussion 66
Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA, Remley KB, Boutin SM, Dunnagan SA (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226:366–372
McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF (2002) Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 13:883–886
Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265
Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124
Melton LJ 3rd, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221
Briggs AM, Wrigley TV, van Dieen JH, Phillips B, Lo SK, Greig AM, Bennell KL (2006) The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo. Eur Spine J 15:1785–1795
Lindsay R, Burge RT, Strauss DM (2005) One year outcomes and costs following a vertebral fracture. Osteoporos Int 16:78–85
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Gaitanis IN, Carandang G, Phillips FM, Magovern B, Ghanayem AJ, Voronov LI, Havey RM, Zindrick MR, Hadjipavlou AG, Patwardhan AG (2005) Restoring geometric and loading alignment of the thoracic spine with a vertebral compression fracture: effects of balloon (bone tamp) inflation and spinal extension. Spine J 5:45–54
Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB (2006) Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine (Phila Pa 1976) 31:435–441
Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836
Movrin I, Vengust R, Komadina R (2010) Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg 130:1157–1166
Rho YJ, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J 21:905–911
Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 29:580–585
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None. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
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Baek, SW., Kim, C. & Chang, H. The relationship between the spinopelvic balance and the incidence of adjacent vertebral fractures following percutaneous vertebroplasty. Osteoporos Int 26, 1507–1513 (2015). https://doi.org/10.1007/s00198-014-3021-x
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DOI: https://doi.org/10.1007/s00198-014-3021-x