J Korean Soc Spine Surg.  2017 Jun;24(2):80-86. 10.4184/jkss.2017.24.2.80.

Survival Analysis Based on the Incidence of a New Fracture in an Adjacent Vertebra After Vertebroplasty or Kyphoplasty

• Kim SS
• Kim DH
• Kim JH

• KMID: 2385643
• DOI: http://doi.org/10.4184/jkss.2017.24.2.80

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the factors affecting the incidence of new vertebral fractures and the survival rate associated with the occurrence of a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for single-vertebral body fracture due to osteoporosis. SUMMARY OF LITERATURE REVIEW: It is controversial whether adjacent-vertebra fractures after vertebroplasty or kyphoplasty are due to the natural course of osteoporosis or are a complication of vertebroplasty.
MATERIALS AND METHODS
From May 2002 to January 2010, among 490 cases of vertebroplasty and kyphoplasty for the fracture of a single vertebral body due to osteoporosis, 250 cases were analyzed retrospectively, and a survival rate analysis was performed based on the incidence of a new fracture in an adjacent vertebral body. The survival rate analysis was conducted based on age at the time of surgery, gender, surgical method, leakage of cement into the vertebral disc, compression rate before surgery, recovery of vertebral height after surgery, bone density before surgery, surgeon, the presence of diabetes, and smoking. The average follow-up period was 13.8 months (range, 1 month to 7 years and 11 months) and the mean age at the time of surgery was 72.1 years (range, 47-92 years).
RESULTS
Among the 250 cases, a new fracture in an adjacent vertebral body occurred in 30 cases (12%). The 1-year survival rate of patients undergoing vertebroplastry or kyphoplasty for a vertebral fracture was 88.4%, the 5-year rate was 66.8%, and the 7-year rate was 53.5%. When the cases were analyzed according to whether the patient's age at the time of surgery was under or over 70 years, the survival rate was significantly higher in the under-70 group (p=0.026). Moreover, when analyzing the survival rate using a 3% vertebral height recovery rate after surgery as baseline, the group that showed 3% or less had a significantly higher survival rate (p=0.04); moreover, the survival rate was significantly higher in patients with a bone density higher than −3.6 (p=0.046). In multiple factor analysis, age at the time of surgery (p=0.022) and the vertebral height recovery rate after surgery (p=0.046) were found to be statistically significant factors.
CONCLUSIONS
The survival rate associated with a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for osteoporotic compression fractures was significantly decreased at 1, 5, and 7 years. Based on the survival rate analysis, the most crucial factors were age and the vertebral height recovery rate after surgery.

Keyword

Osteoporosis; Vertebral compression fracture; Vertebroplasty; Kyphoplasty

MeSH Terms

Bone Density
Follow-Up Studies
Fractures, Compression
Humans
Incidence*
Kyphoplasty*
Methods
Osteoporosis
Retrospective Studies
Smoke
Smoking
Spine*
Survival Analysis*
Survival Rate
Vertebroplasty*
Smoke

Figure

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  Fig. 1. Receive operating characteristic curve.

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  Fig. 2. The graph of survival rate.

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  Fig. 3. Univariate analysis (A) age (B) reduction rate (C) preoperative BMD.

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