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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.

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We are thankful to the Swiss Spine Society and the SWISSspine registry group who made this research possible by populating the database with their valuable and much appreciated entries. The Kyphoplasty group contributing data to the current study is comprised of the following surgeons (in order of case contribution): Michael Schüler (n = 44), Thomas Forster (n = 38), Gianluca Maestretti (n = 26), Urs Mueller (n = 23), Stefan Schären (n = 23), Max Aebi (n = 20), Markus Kröber (n = 19), Bruno Beele (n = 16), Ivan Broger (n = 16), Friedrich Sgier (n = 16), Martin Blay (n = 13), Ulrich Berlemann (n = 11), Thomas Lutz (n = 11), Christian Etter (n = 10), Christian Bärlocher (n = 8), Christoph Binkert (n = 8), Patrick Moulin (n = 7), Fabrice Külling (n = 6), Stefan Kunz (n = 5), Thomas Markwalder (n = 5), Uwe Schwarz (n = 5), Bijan Cheikh-Sarraf (n = 4), Bernhard Jeanneret (n = 4), Marc Morard (n = 4), Enrico Tessitore (n = 4)Oliver Hausmann (n = 3), Karen Heimberger (n = 3), Philip Otten (n = 3), Michael Payer (n = 3), Andreas Schirm (n = 3), Christof Hamburger (n = 2), Thomas M. Stoll (n = 2), Kristof Van Dommelen (n = 2), Martin Baur (n = 1), Michael Heinzelmann (n = 1), Knutti Oliver (n = 1), Rosa Martinez (n = 1), Aymen Ramadan (n = 1), Othmar Schwarzenbach (n = 1), Oliver Vernet (n = 1), Guido Wanner (n = 1).

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The authors, or any member of their family, did not have any conflict of interest or financial support related to the subject of this article.

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Correspondence to Fabrice A. Kuelling.

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Spross, C., Aghayev, E., Kocher, R. et al. Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry. Eur Spine J 23, 1332–1338 (2014).

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  • Balloon kyphoplasty
  • Adjacent segment fracture
  • SWISSspine registry
  • Risk factors
  • Rheumatoid arthritis