J Korean Soc Spine Surg.  2015 Sep;22(3):75-81. 10.4184/jkss.2015.22.3.75.

Analysis of Treatment Methods for Subsequent Vertebral Fractures Following Osteoporotic Compression Fractures

• Kim JH
• Kim SS
• Lee DH
• Lim DJ
• Choi BW
• Kim JH
• Kim JH
• Chung SJ

• KMID: 2068924
• DOI: http://doi.org/10.4184/jkss.2015.22.3.75

Abstract

STUDY DESIGN: A multicenter retrospective study.
OBJECTIVES
To compare the incidence and pattern of subsequent vertebral fractures following conservative treatment versus vertebroplasty or kyphoplasty for acute osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: Previous studies suggest that new vertebral fractures may increase following vertebroplasty or kyphoplasty because bony cement inserted into the vertebral body of a fractured bone can elevate its strength and stiffness, which in turn, may increase the probability of the compression fractures.
MATERIALS AND METHODS
From three hospitals, we recruited 135 patients who had been treated for acute osteoporotic compression fractures and had available spine images taken at their 1-year follow-up. The patients were divided into two groups according to treatment methods. Group C had been managed conservatively, and Group VK had undergone vertebroplasty or kyphoplasty. The two groups were compared for subsequent vertebral fractures.
RESULTS
Group C consisted of 76 patients, and Group VK had 59. There were no significant differences between the two groups in terms of age, sex, medical comorbidity, body mass index (BMI), bone mineral density, presence of prior vertebral fracture or acute fracture level (p>0.05). New vertebral fractures were detected in 25 patients (19% of total subjects): 6 (8%) from Group C, and 19 (32%) from Group VK, demonstrating a significantly higher incidence in the VK group (p=0.0007). In the subgroup analysis, there was no significant difference between vertebroplasty and kyphoplasty (p>0.05). While four of the six patients (67%) in Group C had subsequent fractures in nonadjacent vertebrae, 14 of the 19 patients (74%) in Group VK had subsequent fractures in adjacent vertebrae.
CONCLUSIONS
Subsequent vertebral fractures were found in 19% of subjects at one year after treatment for acute osteoporotic compression fractures. Compared with conservative treatment, vertbroplasty or kyphoplasty significantly increased the occurrence of subsequent vertebral fractures, which appeared more often in adjacent vertebrae.

Keyword

Osteoprotic compression fracture; Subsequent vertebral fracture; Vertebroplasty; Kyphoplasty

MeSH Terms

Body Mass Index
Bone Density
Comorbidity
Follow-Up Studies
Fractures, Compression*
Humans
Incidence
Kyphoplasty
Methods*
Retrospective Studies
Spine
Vertebroplasty

Figure

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  Fig. 1. (A) A 67 year-old female with vertebral compression fracture at L1 was treated with vertebroplasty (VP). (B) One year after VP, there was a newly developed subsequent compression fracture at proximal adjacent vertebra, T12.

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