Single-level vertebral kyphoplasty is not associated with an increased risk of symptomatic secondary adjacent osteoporotic vertebral compression fractures: a matched case–control analysis
This matched case–control study compared the rate of symptomatic adjacent-level vertebral compression fractures (VCF) within 1 year in patients operatively treated with kyphoplasty to a control group of non-operatively treated VCFs. The adjacent-level fracture rate did not show a significant difference between groups.
To compare the rate of new symptomatic adjacent-level fractures within 1 year after an isolated osteoporotic vertebral compression fracture (VCF) treated by either kyphoplasty or non-operative treatment.
Patients aged ≥ 50 years with an isolated, fresh, and symptomatic osteoporotic VCF who were treated by kyphoplasty were compared to patients of similar age, gender, vertebral segment, and bone mineral density who were treated non-operatively (n = 98). A matched case–control analysis was conducted by retrospective chart review, and the rate of new adjacent-level symptomatic vertebral fractures, defined as occurring within two segments of the index fracture, within the first year was determined.
Ninety-eight patients (66 female, aged 73.5, SD 9.7 years) were analyzed in this matched case–control study. The adjacent fracture rate within 1 year was not different between the kyphoplasty group and the non-operative group (20.4 vs 18.4%; McNemar, p = 1.0). The time to a new adjacent fracture after the index fracture was significantly shorter in the kyphoplasty (7, SD 8 weeks) versus non-operative group (22, SD 13 weeks).
Patients with osteoporotic VCFs treated with kyphoplasty did not show an increased rate of additional symptomatic adjacent-level VCFs when compared to a non-operative control group matched for age, gender, fracture level, and bone mineral density.
Level of Evidence: Level III.
KeywordsVertebral compression fracture Spinal fracture Kyphoplasty Adjacent-level vertebral fracture Adjacent vertebral fracture Osteoporosis Dual energy X-ray absorptiometry Bone mineral density
Compliance with ethical standards
The study was approved by the local ethics committee (Kantonale Ethik-Kommission Zürich, KEK-ZH-Nr. 2017-00408).
Conflicts of interest
Georg Osterhoff has given paid lectures for Medtronic, Stryker, and Stöckli Medical, all three being manufacturers or distributors of kyphoplasty systems. Henrik Teuber, Simon Tiziani, Sascha Halvachizadeh, Diana Frey, Kai Sprengel, and Hans-Christoph Pape declare that they have no conflict of interest.
- 7.Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024CrossRefGoogle Scholar
- 10.Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2009) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20:819–826CrossRefGoogle Scholar
- 17.Faloon MJ, Ruoff M, Deshpande C, Hohman D, Dunn C, Beckloff N, Patel DV (2015) Risk factors associated with adjacent and remote-level pathologic vertebral compression fracture following balloon kyphoplasty: 2-year follow-up comparison versus conservative treatment. 25:313–319Google Scholar
- 19.Ning L, Wan S, Liu C, Huang Z, Cai H, Fan S (2015) New levels of vertebral compression fractures after percutaneous kyphoplasty: retrospective analysis of styles and risk factors. Group 77:0.025Google Scholar
- 23.Breslow NE, Day NE (1980) Statistical methods in cancer research. Volume I—the analysis of case–control studies. IARC Sci Publ:5–338Google Scholar
- 29.Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Am J Neuroradiol 27:217–223Google Scholar
- 30.Boonen S, Eastell R, Su G, Mesenbrink P, Cosman F, Cauley JA, Reid IR, Claessens F, Vanderschueren D, Lyles KW, Black DM (2012) Time to onset of antifracture efficacy and year-by-year persistence of effect of zoledronic acid in women with osteoporosis. J Bone Miner Res 27:1487–1493CrossRefGoogle Scholar
- 32.Mannil M, Eberhard M, Becker AS, Schönenberg D, Osterhoff G, Frey DP, Konukoglu E, Alkadhi H, Guggenberger R (2017) Normative values for CT-based texture analysis of vertebral bodies in dual X-ray absorptiometry-confirmed, normally mineralized subjects. Skelet Radiol 46:1541–1551CrossRefGoogle Scholar