Journal List > J Korean Soc Spine Surg > v.22(3) > 1076081

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Kim, Kim, Lee, Lim, Choi, Kim, Kim, and Chung: Analysis of Treatment Methods for Subsequent Vertebral Fractures Following Osteoporotic Compression Fractures
Original Article

Journal of Korean Spine Surg 2015;22(3):75-81.

Published online: 21 September 2015

DOI: https://doi.org/10.4184/jkss.2015.22.3.75

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

Jung Hoon Kim, M.D., Sung Soo Kim, M.D.∗, Dong Hyun Lee, M.D.∗, Dong Ju Lim, M.D.†, Byung Wan Choi, M.D.∗, Jin Hwan Kim, M.D., Jin Hyok Kim, M.D.†, Sung Jae Chung, M.D.†

Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, College of Medicine, Goyang, Korea

∗Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea

†Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University, College of Medicine, Seoul, Korea

Corresponding author: Sung Soo Kim, M.D. Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Korea*875, Haeun-daero, Haeundae-gu, Busan 612-896, Korea TEL: +82-51-797-0240, FAX: +82-51-797-0249 E-mail: sskim@paik.ac.kr

Received 9 March 2015       Revised 14 May 2015       Accepted 26 June 2015

Copyright © 2015 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 followup. 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.

Keywords: Osteoprotic compression fracture, Subsequent vertebral fracture, Vertebroplasty, Kyphoplasty

REFERENCES

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Figures and Tables%

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.
jkss-22-75f1.tif
Table 1.
Demographics and BMD data
C group (N=76) VK group (N=59) P value
Age 72.9±8.2(54~92) 72.2±7.1(59~88) >0.05
Female/Male 70/6 49/10 >0.05
Body mass index (kg/m2) 23.4±3.4 22.5±3.4 >0.05
Medical comorbidity
 No 29 18 >0.05
 Yes 47 41
Lumbar BMD
 g/cm2 0.714±0.128 0.710±0.148 >0.05
 T-score -3.06±1.03 -3.12±1.19 >0.05
Femur neck BMD
 g/cm2 0.616±0.106 0.603±0.110 >0.05
 T-score -2.15±0.92 -2.36±0.92 >0.05
Femur total BMD
 g/cm2 0.674±0.126 0.659±0.140 >0.05
 T-score -1.94±1.05 -2.14±1.14 >0.05
Table 2.
Initial Radiographic Data
C group (N=76) VK group (N=59) P value
Acute fracture level
 Thoracic spine 6 5 >0.05
 Thoracolumbar spine 59 44
 Lumbar spine 11 10
Prior vertebral fracture
 No 51 40 >0.05
 Yes 25 19
Table 3.
Analysis of Subsequent Vertebral Compression Fracture
C group (N=76) VK group (N=59) P value
Subsequent fracture
 No 70 40 0.0007
 Yes 6 19
The number of fractures
 Single 3 16 >0.05
 Multiple 3 3
Fracture level
 Nonadjacent vertebra 4 5 UA*
 Adjacent vertebra 2 11
 Nonadjacent & adjacent vertebra 0 3

*UA: unavailable

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