Journal List > J Korean Soc Spine Surg > v.24(2) > 1076161

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

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.

REFERENCES

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Fig. 1.
Receive operating characteristic curve.
jkss-24-80f1.tif
Fig. 2.
The graph of survival rate.
jkss-24-80f2.tif
Fig. 3.
Univariate analysis (A) age (B) reduction rate (C) preoperative BMD.
jkss-24-80f3.tif
Table 1.
Demographic and clinical data obtained in patients
Parameter value
No. of patient 250
Gender, No of M:F 37: 213
Vertabroplasty: kyphoplasty 119: 131
Mean age(years) 72.1
Mean BMD(T-score) −3.0
No. of DM 35
No. of Smoking 24
No. of adjacent fracture 30
Follow up period(months) 13.7
Level, No. of TL: Others 153:97
No. of Cement leakage  
  Proximal 47
  Distal 13
  mixed 5
Table 2.
New fracture at adjacent vertebra
Vertebroplasty Kyphoplasty Number of new fracture Proximal adjacent new fracture Distal adjacent new fracture
T7 1 1  
T8 1   1
T11 5 3 2
T12 3 2 1
L1 10 6 4
L2 8 6 2
L3 1 1  
L4 1   1
Total 30/250 (12%) 19 (63.3%) 11 (36.7%)
Table 3.
Risk factors (Univariate analysis)
Risk factors p Hazard ratio CI
Age: <70 vs≥70 0.026 0.403 0.195∼0.829
Postop. Reduction rate: >3 vs≤3 0.04 0.420 0.200∼0.880
Preop BMD: >-3.6 vs≤-3.6 0.046 0.476 0.192∼1.179
Table 4.
Risk factors (Multivariate analysis)
Variables Hazard ratio CI p
Age      
  <70 0.347 0.141∼0.853 0.022
  ≥70 1.00    
Postop. Reduction rate      
  ≤3 0.362 0.134∼0.976 0.046
  >3 1.00    
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