European Spine Journal

, Volume 23, Issue 6, pp 1332–1338 | Cite as

Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry

  • Christian Spross
  • Emin Aghayev
  • Rouven Kocher
  • Christoph Röder
  • Thomas Forster
  • Fabrice A. Kuelling
Original Article

Abstract

Purpose

The SWISSspine registry (SSR) was launched in 2005 to assess the safety and effectiveness of balloon kyphoplasty (BKP). In the meantime, repeated reports on high rates of adjacent vertebral fractures (ASF) after BKP of vertebral insufficiency fractures were published. The causes for ASF and their risk factors are still under debate. The purpose of this study was to report the incidence and potential risk factors of ASF within the SSR dataset.

Methods

The SSR data points are collected perioperatively and during follow-ups, with surgeon- and patient-based information. All patients documented with a monosegmental osteoporotic vertebral insufficiency fracture between March 2005 and May 2012 were included in the study. The incidence of ASF, significant associations with co-variates (patient age, gender, fracture location, cement volume, preoperative segmental kyphosis, extent of kyphosis correction, and individual co-morbidities) and influence on quality of life (EQ-5D) and back pain (VAS) were analyzed.

Results

A total of 375 patients with a mean follow-up of 3.6 months was included. ASF were found in 9.9 % (n = 37) and occurred on average 2.8 months postoperatively. Preoperative segmental kyphosis >30° (p = 0.026), and rheumatoid arthritis (p = 0.038) and cardiovascular disease (p = 0.047) were significantly associated with ASF. Furthermore, patients with ASF had significantly higher back pain at the final follow-up (p = 0.001). No further significant associations between the studied co-variates and ASF were seen in the adjusted analysis.

Conclusions

The findings suggest that patients with a preoperative segmental kyphosis >30° or patients with co-morbidities like rheumatoid arthritis and a cardiovascular disease are at high risk of ASF within 6 months after the index surgery. In case of an ASF event, back pain levels are significantly increased.

Level of evidence

IV.

Keywords

Balloon kyphoplasty Adjacent segment fracture SWISSspine registry Risk factors Rheumatoid arthritis 

References

  1. 1.
    Borgstrom F, Sobocki P, Strom O, Jonsson B (2007) The societal burden of osteoporosis in Sweden. Bone 40:1602–1609. doi:10.1016/j.bone.2007.02.027 PubMedCrossRefGoogle Scholar
  2. 2.
    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. doi:10.1007/s00198-006-0257-0 PubMedCrossRefGoogle Scholar
  3. 3.
    Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, Juniper EF (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756PubMedCrossRefGoogle Scholar
  4. 4.
    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) 26:1511–1515CrossRefGoogle Scholar
  5. 5.
    Diel P, Reuss W, Aghayev E, Moulin P, Röder C, Group obotSR (2010) SWISSspine-a nationwide health technology assessment registry for balloon kyphoplasty: methodology and first results. Spine J: Off J North Am Spine Soc 10:961–-971. doi:10.1016/j.spinee.2009.08.452
  6. 6.
    Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM (2006) Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J 15:1050–1067. doi:10.1007/s00586-005-0048-x PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Hadjipavlou AG, Tzermiadianos MN, Katonis PG, Szpalski M (2005) Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg Br 87:1595–1604. doi:10.1302/0301-620X.87B12.16074 PubMedCrossRefGoogle Scholar
  8. 8.
    Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 16:1085–1100. doi:10.1007/s00586-007-0308-z PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84:748–752PubMedCrossRefGoogle Scholar
  10. 10.
    Kim MJ, Lindsey DP, Hannibal M, Alamin TF (2006) Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions. Spine 31:2079–2084. doi:10.1097/01.brs.0000231714.15876.76 PubMedCrossRefGoogle Scholar
  11. 11.
    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. doi:10.1016/j.clinbiomech.2004.09.004 CrossRefGoogle Scholar
  12. 12.
    Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29:2270–2276 (discussion 2277)PubMedCrossRefGoogle Scholar
  13. 13.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323. joc02244 piiPubMedCrossRefGoogle Scholar
  14. 14.
    Lunt M, O’Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513. S8756328203002485 piiPubMedCrossRefGoogle Scholar
  15. 15.
    Aghayev E, Henning J, Munting E, Diel P, Moulin P, Röder C (2012) Comparative effectiveness research across two spine registries. Eur Spine J (In press)Google Scholar
  16. 16.
    Eurospine (2012) Spine Tango. http://www.eurospine.org/p31000381.html
  17. 17.
    Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108PubMedCrossRefGoogle Scholar
  18. 18.
    Harrop JS, Prpa B, Reinhardt MK, Lieberman I (2004) Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty. Spine 29:2120–2125PubMedCrossRefGoogle Scholar
  19. 19.
    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. doi:10.1007/s00402-010-1106-3 PubMedCrossRefGoogle Scholar
  20. 20.
    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 373:1016–1024. doi:10.1016/S0140-6736(09)60010-6 PubMedCrossRefGoogle Scholar
  21. 21.
    Frankel BM, Monroe T, Wang C (2007) Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J: Off J North Am Spine Soc 7:575–582. doi:10.1016/j.spinee.2006.10.020 CrossRefGoogle Scholar
  22. 22.
    Pflugmacher R, Schroeder R-J, Klostermann CK (2006) Incidence of adjacent vertebral fractures in patients treated with balloon kyphoplasty: two years’ prospective follow-up. Acta radiologica (Stockholm, Sweden: 1987) 47:830–840. doi:10.1080/02841850600854928 Google Scholar
  23. 23.
    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. doi:10.1359/jbmr.2000.15.4.721 PubMedCrossRefGoogle Scholar
  24. 24.
    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. doi:10.1016/j.spinee.2004.05.248 PubMedCrossRefGoogle Scholar
  25. 25.
    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. doi:10.1007/s00586-011-2099-5 PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    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. doi:10.1007/s00586-006-0158-0 PubMedCrossRefGoogle Scholar
  27. 27.
    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 31:435–441. doi:10.1097/01.brs.0000200036.08679.1e PubMedCrossRefGoogle Scholar
  28. 28.
    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 373:1016–1024. doi:10.1016/S0140-6736(09)60010-6 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Christian Spross
    • 1
  • Emin Aghayev
    • 2
  • Rouven Kocher
    • 1
  • Christoph Röder
    • 2
  • Thomas Forster
    • 1
  • Fabrice A. Kuelling
    • 1
  1. 1.Department of Orthopaedics and TraumatologyKantonsspital St. GallenSt. GallenSwitzerland
  2. 2.Institute for Evaluative Research in Orthopaedic SurgeryUniversity of BernBernSwitzerland

Personalised recommendations