Yonsei Med J.  2007 Aug;48(4):645-652. 10.3349/ymj.2007.48.4.645.

The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved

Affiliations
  • 1Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. haksunkim@yuhs.ac
  • 2Department of Orthopedic Surgery, Cha University College of Medicine, Sungnam, Korea.
  • 3Department of Orthopedic Surgery, National Health Insurance Corporation, Ilsan Hospital, Koyang, Korea.
  • 4Department of Anesthesiology and Pain Medicine, National Health Insurance Corporation, Ilsan Hospital, Koyang, Korea.
  • 5Department of Orthopaedic Surgery, Ahnsei Hospital, Seoul, Korea.

Abstract

PURPOSE
To identify the incidence of new vertebral compression fractures in women after kyphoplasty and to analyze influential factors in these patients. MATERIALS AMD METHODS: One hundred and eleven consecutive female patients with osteoporotic vertebral compression fractures (VCFs) underwent kyphoplasty at 137 levels. These patients were followed for 15.2 months postoperatively. For the survey of new vertebral compression fractures, medical records and x-rays were reviewed, and telephone interviews were conducted with all patients. RESULTS: During that time 20 (18%) patients developed new VCFs. The rate of occurrence of new VCFs in one year was 15.5% using a Kaplan-Meier curve. Body mass index (BMI), symptom duration and kyphoplasty level were the statistically significant factors between the patient groups both with and without new VCFs after kyphoplasty. In the comparison between the adjacent and remote new VCF groups, the adjacent new VCF group showed a larger amount of polymethyl methacrylate (PMMA) use during kyphoplasty (p<0.05). Before kyphoplasty, 9.9% of the patients had been prescribed medication for osteoporosis, and 93.7% of the patients started or continued medication after kyphoplasty. The development of new VCFs was affected by the number of vertebrae involved in the kyphoplasty. However, the lower incidence rate (15.5%) of new compression fractures might be due to a greater percentage (93.7% in our study) of patients taking anti-osteoporotic medication before and/or after kyphoplasty. CONCLUSION: When kyphoplasty is planned for the management of patients with osteoporotic VCFs, the application of a small amount of PMMA can be considered in order to lower the risk of new fractures in adjacent vertebrae. The postoperative use of anti- osteoporotic medication is recommended for the prevention of new VCFs.

Keyword

Kyphoplasty; compression fracture; influencing factor

MeSH Terms

Aged
Aged, 80 and over
Bone Cements
Female
Follow-Up Studies
Fractures, Compression/epidemiology/*surgery
Humans
Incidence
Middle Aged
Orthopedic Procedures
Postoperative Complications
Recurrence
Risk Factors
Spinal Fractures/epidemiology/*surgery
Surgical Procedures, Minimally Invasive
Treatment Outcome

Figure

  • Fig. 1 A Kaplan-Meier Product-Limit Survival Curve depicting the disease-free survival rate without additional fracture for patients with compression fractures over time. The mean one-year survival rate is 84.5%.


Cited by  6 articles

At Least One Cyclic Teriparatide Administration Can Be Helpful to Delay Initial Onset of a New Osteoporotic Vertebral Compression Fracture
Kyung Soo Suk, Hwan Mo Lee, Seong-Hwan Moon, Hee June Kim, Hak Sun Kim, Jin-Oh Park, Byung Ho Lee
Yonsei Med J. 2014;55(6):1576-1583.    doi: 10.3349/ymj.2014.55.6.1576.

Effect of Intravenous Administration of Bisphosphonate for Patients Operatively Treated for Osteoporotic Hip Fracture
Sang Hong Lee, Woong Chae Na, Yi Kyu Park
Hip Pelvis. 2012;24(2):133-138.    doi: 10.5371/hp.2012.24.2.133.

Does the Time of Postoperative Bisphosphonate Administration Affect the Bone Union in Osteoporotic Intertrochanteric Fracture of Femur?
Yoon Je Cho, Young Soo Chun, Kee Hyung Rhyu, Joon Soon Kang, Gwang Young Jung, Jun Hee Lee
Hip Pelvis. 2015;27(4):258-264.    doi: 10.5371/hp.2015.27.4.258.

Risk Factors for the Progressive Osteoporotic Spinal Fracture
Jong-Min Sohn, Ki-Won Kim, Kee-Yong Ha, Nan-Kyoung Ha, Young-Hoon Kim, Ju-Hwan Kim
J Korean Soc Spine Surg. 2009;16(3):153-159.    doi: 10.4184/jkss.2009.16.3.153.

Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI
Jae-Yoon Chung, Ji-Hyeon Yim, Hyoung-Yeon Seo, Ha-Sung Kim, Do-Youn Kim
J Korean Soc Spine Surg. 2012;19(3):90-96.    doi: 10.4184/JKSS.2021.19.3.90.

Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures
Min-Wook Kim, Dae-Hyun Yoon, Sang-Ho Ahn, Ji-Won Lee, Cheol-Hwan Kim, Yong-Soo Choi
J Korean Soc Spine Surg. 2015;22(4):146-152.    doi: 10.4184/jkss.2015.22.4.146.


Reference

1. Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, et al. Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum. 1993. 36:750–756.
Article
2. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999. 159:1215–1220.
3. Takata S, Yasui N. Disuse osteoporosis. J Med Invest. 2001. 48:147–156.
4. Feltes C, Fountas KN, Machinis T, Nikolakakos LG, Dimopoulos V, Davydov R, et al. Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures. Neurosurg Focus. 2005. 18:e5.
Article
5. Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone. 1996. 18(3 Suppl):185S–189S.
Article
6. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis In women. Am Rev Respir Dis. 1990. 141:68–71.
Article
7. Rhyne A, Banit D, Laxer E, Odum S, Nussman D. Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma. 2004. 18:294–299.
Article
8. Crandall D, Slaughter D, Hankins PJ, Moore C, Jerman J. Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results. Spine J. 2004. 4:418–424.
Article
9. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine. 2001. 26:1511–1515.
10. Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine. 2001. 26:1631–1638.
Article
11. Majd ME, Farley S, Holt RT. Preliminary outcomes and efficacy of the first 360 consecutive kyphoplasties for the treatment of painful osteoporotic vertebral compression fractures. Spine J. 2005. 5:244–255.
Article
12. Phillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine. 2003. 28:2260–2267.
Article
13. Donovan MA, Khandji AG, Siris E. Multiple adjacent vertebral fractures after kyphoplasty in a patient with steroid-induced osteoporosis. J Bone Miner Res. 2004. 19:712–713.
Article
14. Fribourg D, Tang C, Sra P, Delamarter R, Bae H. Incidence of subsequent vertebral fracture after kyphoplasty. Spine. 2004. 29:2270–2277.
Article
15. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000. 15:721–739.
Article
16. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001. 285:320–323.
Article
17. Do HM. Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty. Top Magn Reson Imaging. 2000. 11:235–244.
Article
18. Jahng JS, Moon SH. Correlation of the bone mineral density with morphometric dimensions and characteristics of osteoporotic vertebral fracture. J Korean Orthop Assoc. 1998. 33:375–384.
Article
19. Ananthakrishnan D, Berven S, Deviren V, Cheng K, Lotz JC, Xu Z, et al. The effect on anterior column loading due to different vertebral augmentation techniques. Clin Biomech (Bristol, Avon). 2005. 20:25–31.
Article
20. Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine. 2001. 26:151–156.
Article
21. Villarraga ML, Bellezza AJ, Harrigan TP, Cripton PA, Kurtz SM, Edidin AA. The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies. J Spinal Disord Tech. 2005. 18:84–91.
Article
22. Kayanja MM, Togawa D, Lieberman IH. Biomechanical changes after the augmentation of experimental osteoporotic vertebral compression fractures in the cadaveric thoracic spine. Spine J. 2005. 5:55–63.
Article
23. Harrop JS, Prpa B, Reinhardt MK, Liberman I. Primary and secondary osteoporosis' incidence of subsequent vertebral compression fractures after kyphoplasty. Spine. 2004. 29:2120–2125.
Article
24. Ravn P, Cizza G, Bjarnason NH, Thompson D, Daley M, Wasnich RD, et al. Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group. J Bone Miner Res. 1999. 14:1622–1627.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr