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Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy

Angrenzende Wirbelkörperfrakturen nach osteoporotischen Wirbelkörper-Kompressionsfrakturen: Prospektive nicht-randomisierte Studie zum Vergleich der Ballonkyphoplastie und der konservativen Therapie

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Summary

Background

In literature, there are conflicting clinical data regarding the incidence of subsequent fracture after balloon kyphoplasty (BK); moreover, the risk of adjacent vertebral fractures has not been well established because there are limited comparative data available with conservatively treated control groups.

Purpose

The purpose of this prospective nonrandomized comparative study was to analyze the incidence and possible risk factors of adjacent level fracture comparing BK with conservative therapy.

Methods

Consecutive patients satisfying the inclusion criteria of acute vertebral fracture pain (occurring within 1–6 weeks of the event and not relieved by oral analgesia) and imaging criteria of acute fracture activity were enrolled. All patients meeting the inclusion criteria were offered BK. The patients who declined BK and agreed to longitudinal evaluation were treated conservatively and constituted the control group.

Results

In 3 out of 46 patients (6.5 %) treated with BK and in 10 out of 61 patients treated conservatively (16.4 %), the adjacent level fracture occurred within 1 year. The degree of local kyphosis and bone mineral density (BMD) were identified as important predictive factors for adjacent level fracture.

Conclusion

These results indicated that BK carries a low risk of adjacent level fractures. Lower BMD values and altered biomechanics in the treated area of the spine due to resistant kyphosis are possible predictive factors for adjacent level fractures. A positive effect of BK over conventional treatment was observed upon reduction of the incidence of adjacent level fracture, vertebral morphology, and pain reduction.

Zusammenfassung

Grundlagen

In der veröffentlichten Literatur bestehen gegensprüchliche Fakten bezüglich Brüchen der Nachbarwirbel nach eingesetzter Ballonkyphoplastie (BK), darüber hinaus steht eine begrenzte Zahl vergleichbarer Untersuchungen zwischen BK und der konservativen Behandlung zur Verfügung.

Ziel

Ziel der präsentierten prospektiven nicht‐randomisierten Studie war es, Häufigkeit und mögliche Risikofaktoren für Frakturen angrenzender Wirbelkörper nach eingesetzter BK im Vergleich mit einer konservativen Therapie einzuschätzen.

Methodik

In Studie eingeschlossen waren Patienten mit klinischen und röntgenologischen Zeichen eines osteoporotischen Wirbelbruches (Alter des Bruches < 6 Wochen), sowie starken Schmerzen trotz Analgesie. Allen Patienten, die Schlüsselkriterien erfüllt haben, wurde die Möglichkeit einer BK‐Therapie als alternative Heilung vorgestellt. Patienten, die sich nicht für die operative Therapie entschieden haben, wurden mit deren Zustimmung weiter konservativ behandelt und repräsentierten die Kontrollgruppe der Patienten.

Ergebnisse

In der Gruppe der Patienten nach durchgeführter BK kam es innerhalb 1 Jahres bei 3 von 36 Patienten (6,5 %) zum Bruch eines angrenzenden Wirbelkörpers. Unter Patienten, welche konservativ behandelt wurden, erlitten innerhalb 1 Jahres 10 von 61 Patienten (16,4 %) einen Bruch eines angrenzenden Wirbelkörpers. Gefunden wurde ein möglicher Zusammenhang zwischen der Häufigkeit von Brüchen angrenzender Wirbelkörper mit lokaler Kyphose und der Mineraldichte der Knochen.

Schlussfolgerung

Die Ergebnisse zeigen, dass die BK eine Methode mit geringem Risiko für Brüche der angrenzenden Wirbelkörper ist. Es besteht ein möglicher Zusammenhang zwischen der Häufigkeit angrenzender Wirbelkörperfrakturen bei Osteoporose und der Häufigkeit angrenzender Wirbelkörperfrakturen bei veränderter Biomechanik der Wirbelsäule aufgrund einer lokalen Kyphose. Bei Patienten, behandelt mit BK, gab es im Vergleich mit konservativ therapierten Patienten nach 1 Jahr im Durchschnitt weniger‐ausgeprägte Deformationen der Wirbel, weniger Brüche angrenzender Wirbelkörper und schnellere Schmerzlinderung.

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The author declares that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Traumatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia

    Igor Movrin Ph.D., M.D.

  2. Faculty of Medicine, Department of Surgery, University of Maribor, Maribor, Slovenia

    Igor Movrin Ph.D., M.D.

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Correspondence to Igor Movrin Ph.D., M.D..

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Movrin, I. Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy. Wien Klin Wochenschr 124, 304–311 (2012). https://doi.org/10.1007/s00508-012-0167-4

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  • DOI: https://doi.org/10.1007/s00508-012-0167-4

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