Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry
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.
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.
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.
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
KeywordsBalloon kyphoplasty Adjacent segment fracture SWISSspine registry Risk factors Rheumatoid arthritis
- 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
- 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
- 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.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.Eurospine (2012) Spine Tango. http://www.eurospine.org/p31000381.html
- 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.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
- 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
- 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